Senior Advisory Committee Agenda 05/03/2018May 3, 2018 10:00 AM
Senior Advisory Committee Meeting
3299 Tamiami Trl E
Naples FL, 34112
Fifth Floor Training Room
1. Call to Order
2. Pledge of Allegiance
3. Roll Call
4. Adoption of the Agenda
5. Public Comment
6. Adoption of Minutes from Previous Meeting
6.1. April 4, 2018 Workshop
6.2. April 18, 2018 meeting
7. Staff Reports
7.1. Overview of Collier County
8. New Business
8.1. Adoption of Advisory Committee Procedures
8.2. Chairman Hartman’s Letter
8.3. Committee Mission
8.4. SWOT Analysis
9. Old Business (no action)
10. Announcements
10.1. Electronic Meetings
11. Committee Member Discussion
12. Next Meeting Time, Date and Location
12.1. Next Meeting May 17, 2018 from 10-12AM in the Fifth Floor Training Room Bldg. F
13. Adjournment
The Strategic Plan
•The Strategic Plan
•Sets the scope of agency activity
•Clarifies long-term direction
•Establishes the values and principles that guide the County
•Last year the Commissioners updated the Strategic Plan
•The Strategic Focus Area: Community Health, Wellness and Human Services highlights the need to consider the needs of Seniors
•The Senior Advisory Committee will Identify Issues that relate to the safety and wellbeing of senior citizens in Collier County to support the strategic plan
Gender and Age Distribution
•Collier County is growing at
approximately 2% annually
•The Senior Population is estimated
to be 26.4% by the State
•Age distribution continues to
transition to an older population
•Florida as a whole is aging
•Shift due in part to “baby boomer”
cohort retirement and relocation
Data Source: U.S. Census Bureau
Senior Advisory Committee
•Through the next year we will
•Identify issues that will need to be addressed in the next 5-10 years to
support seniors
•Review similar communities for solutions
•Sarasota
•Lee
•Palm Beach
•Goal: Provide the Commissioners with a report that:
•Prioritizes the needs of the community
•Provides best practices of other communities
•Introduces potential solutions
Collier County Human Services Division
Collier County Services Available
•Case Management
•Adult Day Care
•Personal Care
•Homemaking
•Respite Services
•Chore
•Consumable Medical Supplies
•Emergency Alert Response System
•Nutrition-Home Delivered Meals, Congregate Meal Sites
State & Federal Programs Available
State Programs
•Alzheimer’s Disease Initiative (ADI)
•Community Care for the Elderly (CCE)
•Home Care for the Elderly (HCE)
Federal Programs
•Title III
•OA3B –Support Services
•C1 and C2 –Nutrition Services
•IIIE –Caregiver Support Program
Services for Seniors
•Home Assessment by a Case Manager
•Links with Community Services
•Adult Day Care, Personal Care, Respite, Homemaking, Medical
Transport, Medical Equipment/Nutritional Supplies
•Commitment to independent living
•Can be applied for through the AAA Helpline at: 866-413-5337
Criteria for Eligibility
•Resident of Collier County
•60 years of age or older
•18 year of age ONLY for Alzheimer Disease Initiative
•Impaired because of physical or cognitive deficits
SWOT Analysis
Mission Statement
The mission of the Collier County Senior Advisory Committee is to
identify issues and best practices as they relate to the safety and
wellbeing of senior citizens in Collier County.
SWOT Analysis
•SWOT analysis is a tool to
identify issues
•Build on Strengths
•Minimize Weaknesses
•Seize Opportunities
•Mitigate Threats
•What does the County do and
what should it do for the safety
and wellbeing of senior citizens
•Goal: identify what the county
should address in the next 5-10
years
SWOT Analysis
Value
Innovation
Clown
Status Quo
Ideal
Tinkering
Senior Advisory Committee
April 18, 2018
Collier County Veterans Services Unit
•3 Veterans Services Officers, 1 Transportation Coordinator
•Over 20 years experience assisting veterans with benefits claims & appeals
•Offsite services
•Coordination with local Veterans Services Organizations
•Annual Veterans and Dependents Expo
•www.collierveterans.com
Collier County Veterans
•Collier County has 28,242 Veterans according to latest VA projections.
•21,801 –or 77% -are over the age of 65.
•Collier County ranked #1 in a needs based study for veterans in 2014.
•Collier County is approximate to 8 other counties within a 75 mile radius –capturing a
veterans population exceeding 200,000.
Volunteer Transportation Network
•Collier County provides free transportation to veterans to a multitude of VA
facilities
•In 2017, our volunteers:
•Served 1,188 Veterans
•Drove 54,824 miles
•Donated 1,862 hours of their personal time to our mission.
•Call 239-252-4826 (4VAN) to schedule appointments.
FY18 New Initiatives
•State Veterans Home
•Florida is state a “Great Need” for VA nursing beds –should have 4,909 –actually has 810
•Potential funding from sales tax initiative
•Vouchers for Vets
•Outsourcing of Medical Appeals
•New client management systems
COLLIER COUNTY
Senior Advisory Committee
PROCEDURES FOR SENIOR ADVISORY COMMITTEE
May 3, 2018
A. General:
1. Meetings. Regular meetings of the advisory board shall be held on such
day, time and place as may be determined by the advisory board, and at a
minimum of once a month, except for one month in the summer.
2. Quorum and Voting. At all regular or special meetings of the advisory
board, a majority of the membership of the advisory board shall constitute
a quorum. Voting shall be by voice unless a member of the advisory
board requests a roll call. The roll shall be in alphabetical order with the
first name called rotating with each motion upon which the vote is called.
The Chairman shall always vote last. A record of the roll call shall be kept
as part of the minutes.
3. Special Meetings. Special meetings may be called by the Chairman at
any time provided adequate notice is given pursuant to Paragraph 4 below.
The Chairman may also call a special meeting when requested to do so in
writing by a majority of the members of the advisory board or by a County
staff member. The notice of such a meeting shall specify the purpose of
such a meeting and no other business may be considered except by
unanimous consent of the advisory board. All members of the advisory
board shall be notified in advance of such special meetings by the staff
liaison.
4. Notice and Publication. The staff liaison shall give notice and keep record
of such notice of its meetings and the meeting of the subcommittees
including the date, time, and location of each regular and special meeting.
Notice shall be posted in the county administration building and other
appropriate locations as recommended by the advisory board and to the
County Public Information Department for further distribution.
5. Open Meetings. All meetings of the advisory board or its subcommittees
shall be open to the public and governed by the provisions of Florida's
Government in the Sunshine Law.
6. Minutes. The minutes of all meetings shall be promptly recorded, and
such records shall be open to public inspection, in accordance with
applicable law.
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7. Location. Meetings of the advisory board, or any of its subcommittees,
shall be held in a location accessible to the public.
8. Meeting Agenda. There shall be an agenda for each meeting of the
advisory board which shall determine the order of business conducted.
The board shall not take action on any matter, proposal, report or item of
business not listed upon the official agenda unless a majority of the board
present consents. Any advisory board member, in the case of an advisory
board or a subcommittee member in the case of a subcommittee, may
place an item on the agenda by submitting it to the Chairman for
forwarding to the staff liaison prior to the deadline for publishing the
notice of such meeting. The Chairman shall determine whether the item
submitted by the board member is relevant to the purposes of the advisory
board. Upon his/her finding that the item is relevant, it shall be included
in the agenda. Staff-initiated agenda items are not subject to prior review
by the Chairman.
9. Order of Business. The order of business at regular meetings shall be:
(a) Call to Order
(b) Pledge of Allegiance
(c) Roll Call
(d) Adoption of the Agenda
(e) Public Comment
(f) Adoption of Minutes from Previous Meeting
(g) Staff Reports
(h) New Business
(i) Old Business
(j) Announcements
(k) Committee Member Discussion
(l) Next Meeting Time, Date and Location
(m) Adjournment
B. Agenda Items Requiring Action (Old Business and New Business):
1. General. All members of the public who address the board shall utilize the
speaker's podium to allow their comments to be recorded, and shall
identify themselves by name and local addresses, if applicable. Further,
any speaker speaking on behalf of an organization or group of individuals
(exceeding five) shall indicate such and shall cite the source of such
authority whether by request, petition, vote, or otherwise.
2. Speaker Registration. Persons, other than staff wishing to speak on an
agenda item shall, prior to the item being heard, register with the staff
liaison on the forms provided. Five (5) or more persons deemed by the
board to be associated together or otherwise represent a common point of
view, as proponents or opponents on any item may be requested to select a
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spokesperson. All persons may speak for a maximum of three (3)
minutes each.
3. Restrictions on Comments Deemed Not Germane to the Item.
Notwithstanding any provisions herein, any board member may interrupt
and/or stop any presentation that discusses matters that need not be
considered in deciding the matter then before the board for consideration.
At any board proceeding, the Chairman, unless overruled by majority of
the board members present, may restrict or terminate presentations which
in the Chairman's judgment are frivolous, unduly repetitive or out of order.
C. Order and Subject of Appearance: To the extent possible, the following shall be
the order of the proceeding:
1. Preliminary Statement. The Chairman shall read the title of the agenda
item.
2. Initial Presentation by Staff. County staff shall make the initial
presentation to the board regarding any item under consideration. After
completion of the staff presentation, the board may make inquiries of staff
at this time.
3. Initial Presentation by Petitioner or Proposer. Petitioner or Proposer shall
make the initial presentation to the board regarding any item under
consideration. After completion of the presentation by the Petitioner or
Proposer, the board may make inquiries of the Petitioner or Proposer at
this time.
4. Speakers. After board inquiry, speakers shall be allowed to speak based
on the time limitation guidelines outlined in the preceding subsection B
above. During and after a speaker's presentation, the board shall have an
opportunity to comment or ask questions of or seek clarification from such
speaker. The board may also allow staff to comment, ask questions of or
seek clarification from speakers.
5. Restrictions on Testimony or Presentation of Evidence. Notwithstanding
any provisions herein, any board member may interrupt any presentation
that contains matters which need not be considered in deciding the matter
then before the board for consideration. At any board proceeding, the
Chairman, unless overruled by majority of the board members present,
may restrict or terminate presentations which in the Chairman's judgment
are frivolous, unduly repetitive or out of order.
D. Rules of Debate: The following rules of debate shall be observed by the board.
Except as herein provided questions of order and the conduct of business shall be
governed by Robert's Rules of Order.
1. Motion under consideration. When a motion is presented and seconded, it
is under consideration and no other motion shall be received thereafter,
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except to adjourn, to lay on the table, to postpone, or to amend until the
question is decided. These countermotions shall have preference in the
order in which they are mentioned, and the first two shall be decided
without debate. Final action upon a pending motion may be deferred until
the next meeting by majority of the members present.
2. Chairman participation. The presiding chairman may move, second and
debate from the chair, and shall not be deprived of any of the rights and
privileges of a board member by reason of being the presiding chairman.
3. Form of address. Each member shall address only the presiding officer for
recognition, shall confine himself to the question under debate, and shall
avoid personalities and indecorous language.
4. Interruption. A member, once recognized, shall not be interrupted except
by the Chairman if the Chairman determines that the member's
participation is irrelevant, frivolous or out of order. Any member may
appeal the decision of the Chairman to the board for decision by majority
vote.
5. The question. Upon the closing of debate, any member may require a roll
call vote. Any member may give a brief statement or file a written
explanation of his vote.
E. Public Comment on General Topics: Members of the public may register to speak
on general topics under the Public Comment portion of the agenda. The number
of speakers permitted to register under public comment on any given agenda shall
be limited to a maximum of five, unless the Chairman recognizes additional
speakers.
1. Speaker Registration. Individuals wishing to speak to the board under
public comment at any regularly scheduled meeting of the board shall
register to speak in writing on the form provided by the County prior to
the public comment portion of the agenda being called by the Chairman.
F Reconsideration: There shall be no reconsideration of items before the board.
G. Conflicts of Interest: Any member having a potential voting conflict shall
publicly state the nature of the conflict at the board meeting and complete Form 8B
[Memorandum of Voting Conflict for County, Municipal and Other Local Public
Officers] within 15 days of the scheduled meeting.
____________________
Charles “Doug” Hartman
Chairman
April 23, 2018
Dear Colleagues,
We are now focused on setting the direction the Senior Advisory Committee will take during the next 12
months. Having spent some time thinking about the issue, I would like to share some of my conclusions
and invite your thoughts and those of the public.
The Senior Advisory Committee is an ad hoc committee with a one-year term in which to establish its
usefulness to the Board of County Commissioners. If we succeed, the BCC will establish the Committee
as a permanent advisory body. Therefore, the committee efforts should be consistent with that result. I
think our efforts should:
1. Fill a clear public policy need,
2. Reflect our role as advisors by identifying a problem and recommending a programmatic
solution, not by attempting to solve it ourselves,
3. Contain a clear and complete deliverable in 12 months,
4. Have limited or no budgeting impact,
5. Have the support of the County staff if possible, and
6. Reflect a contribution that justifies making the committee a permanent advisory committee
Please come to the next meeting prepared to raise any issues you think should be added to the list
below and to decide which we should select as our primary focus and which are secondary.
OPTIONS
Among the possible directions we could take are the following:
1. Information Access and Resource Awareness
Are the citizens targeted for use of senior services sufficiently aware of their existence and how
to access them?
2. Senior Citizen Mobility Issues
Are the needs of seniors sufficiently integrated into current County programs and future
planning? This would include areas like public transportation, access to parks and recreation
facilities, safe walking and hiking areas, safe crosswalks, beach access and sitting benches along
major walking corridors.
3. Accessible and affordable transportation
Is public transportation reasonably available to all seniors needing it and at a reasonable cost.
Are the physical needs of seniors incorporated into the vehicles and facilities of the common
areas of the County?
4. Aging in Place, Problems of Elder Isolation, Affordable and Safe Housing
As the average age of our growing population increases, the number of physically and socially
isolated seniors will as well. Do we know who they are, where they are if they are included in
our government programs particularly our emergency response programs?
5. Healthy Nutrition, Food Security and Hunger Reduction
Income in Collier County is very unequally distributed. Is access to adequate nutrition also
unequally distributed? Do we have an older adult hunger problem in parts of Collier County
and, if so, what should be done to mitigate it?
6. Public Image of Quality of Life in Collier County
Numerous national programs exist to rate communities as “healthy” or “happy” or as Blue Zone
Qualified. Should the committee focus on qualifying for one of these titles such as a “most
livable” community? This focus would involve the practical steps we need to take to make the
community even more attractive to newly retired residents and visitors.
7. Senior Center Development
Collier County has two senior centers. Neither are in areas undergoing rapid growth. Where,
how large, how many new senior centers are needed and how will they be financed? How have
other jurisdictions met this need? Should the public sector become directly involved?
8. Lessons Learned from the Hurricane IRMA Recovery
Hurricane Irma uncovered a number of unanticipated issues in Collier County’s Emergency
Response Planning. Some of these are centered on the care and handling of seniors, particularly
immobile seniors, during civil emergencies like extended power outages and flooding. Should
the Committee review these issues and make recommendation beyond what the County staff
has already addressed?
Doug Hartman
Chair
Collier County Senior Advisory Committee
CCollier County:
Community Needs and
Assets Assessment
Acknowledgments
Q-Q Research Consultants would like to thank RMSFF staff, the Collier County community, and col-
leagues who were integral in processes (such as survey development, community engagement, and
data collection) that helped reveal the genuine needs of the Collier County community.
The RMSFF and its Community Assessment Advisory Committee guided the CNA development.
RMSFF is a collaborative body whose mission is to improve the lives of others, particularly U.S. mid-
dle- and working-class families, through results-oriented investments in human and social services,
education, and health and medicine with a special focus on the seven-county metropolitan area of
Minneapolis and St. Paul, and Lee and Collier counties in Florida. Membership on the Community As-
sessment Advisory Committee included the following organizations:
Artis – Naples,
Arthrex, Inc.,
Champions for Learning,
City of Naples,
Collier County Emergency Management
Services,
Collier County Public Schools,
Community Foundation of Collier County,
Conservancy of Southwest Florida,
Collier County Manager’s Office,
Collier County Sheriff’s Office,
Florida Gulf Coast University,
Florida Southwestern College,
Future Ready Collier,
Greater Naples Chamber of Commerce,
Greater Naples Leadership Organization,
Habitat for Humanity,
Healthcare Network of SWFL,
Hodges University,
Immokalee Community Redevelopment
Agency,
Marco Island Police Department,
Naples Children & Education Foundation,
Naples Community Hospital,
Naples Daily News,
Naples Senior Center,
Neighborhood Health Clinic,
Southwest Florida Workforce
Development Board, and
The United Way of Collier County.
Table of Contents
Executive Summary
13
14
14
16
19
20
22
25
37
Introduction
Methodological Approach
Collier County SnapShot
Major Findings and Community Identified Priorities
Report Format
6
12
15
21
37
Employment and Economic Environment
About the Data
Community Engagement: Primary Data
Collier County’s Planning Communities
Disaggregation of data by Geographic Regions and Community Subgroups
Assessment of Prior Reports: Secondary Data
Limitations and Community Need Identification
Collier County Population Data
16 Goals
37 Introduction
38 Data
49 Community Differences and Disparities
53 Key Points
38 Income and Assets
39 Cost of Living
41 Employment and Labor Force
42 Industry and Labor Market
16 Community Surveys
17 Expert-Led Focus Groups
18 Volunteer-Led Focus Groups
54
74
98
111
113
114
Physical Environment
Social Environment and Well-being
Service Environment
Community Identified Priorities
Concluding Foundational Issue
References
54 Introduction
55 Data
70 Community Differences and Disparities
92 Community Differences and Disparities
72 Key Points
55 Housing Affordability and Inventory
61 Transportation Options and Traffic
64 Growth Management and Public Space Maintenance
67 Environment
74 Introduction
75 Data
96 Key Points
75 Health Care Services and Health Insurance
82 Education
86 Other Social Services
108 Community Differences and Disparities
98 Introduction
100 Data
110 Key Points
100 Well-being and Community Cohesion
101 Health and Health Behaviors
103 Recreation and Leisure
104 Safety
6
Executive Summary
1.
2.
3.
Identify and quantify the conditions, needs, and assets of the community,
analyze the access and delivery of resources to the county residents,
provide findings that will allow community leaders and
members to develop priorities and strategies to address
identified needs and gaps while utilizing and mobilizing
existing resources.
1.2.
3.4.]]Identify the needs of all
types of residents within
Collier County, including
those of special and vul-
nerable populations;
Obtain data on popu-
lations for which we
have little quantitative or
qualitative data; and
Build relationships be-
tween the community
and RMSFF.
Identify assets found
within Collier County;
Welcome to the 2017 Collier County Community Needs and Assets Assessment (CNA). The CNA of-
fers a portrait of Collier County and the needs of its residents by presenting data on demographic and
socioeconomic characteristics, as well as an appraisal of economic, physical, service, and social envi-
ronments. The CNA also moves beyond specifics to provide a broader analysis regarding foundational
issues that impact quality of life and assets found within the county.
The CNA addressed three primary objectives:
The CNA employed a community based participatory approach engaging over 4,000 community mem-
bers to achieve the following goals:
7
1.6.
2.7.
3.8.
4.9.
5.10.
Employment and Economic Opportunity Education and Other Social Services
Housing Well-being and Community Cohesion
Transportation/Infrastructure Health and Health Behaviors
Environment Recreation and Leisure
(including Culture and The Arts)
Health Care Safety
In order to achieve these goals and objectives, the CNA involved three steps: 1) community engage-
ment achieved by conducting surveys and focus groups, 2) assessment of prior reports, and 3) com-
munity need identification. The key insights discussed below can be used by stakeholders to make
recommendations for collaborative action incorporating objectives and strategies to meet the identified
needs of Collier County residents while leveraging existing assets.
The CNA identified needs and assets that impact the lives of Collier County residents in the following
domains:
In addition, the CNA identified a foundational issue contributing to local needs: economic barriers for
residents.
Overall, the Collier County community is growing, aging and diversifying. Between 2010 and 2016
the population in Collier County grew by 12.9% to 365,136, out pacing population growth in Florida
(9.2%). Collier is the 16th most populous county in the state, and by 2030, Collier County’s population
is expected to increase over 20%. The population of Collier County is considerably older than that of
the State of Florida and is the 9th ranked county in Florida by percent of population ages 65 and over.
The greatest population growth is anticipated to be among the 65-plus age group, with an expected
increase from about 26% of the total population in 2010 to almost 34% in 2040. Though Collier Coun-
ty’s population is mostly White, the county has a very diverse population of residents (64% identify as
White only, 27% identify as Hispanic Latino, and 7% identify as Black/African American). Growth in
the number of Hispanic/Latino, Black, and multi-ethnic residents is expected to continue on an upward
trend between now and 2040.
8
Employment and Economic Opportunity
Housing
There is a large income gap between the richest and poorest residents of the county. Large segments
of the population earn six-figures (28%), while a considerable percentage live below the federal pov-
erty level (FPL) (17%). The top 1% of residents in the county have an average household income of
$4,191,055, while the bottom 99% have an average household income of $57,258. The cost of living in
Collier County is high for many residents. The minimum sustainable living wage for a family of 4 is esti-
mated to be at $66,127, higher than the average household income for the bottom 99%. A considerable
percentage of families (34%) have difficulty meeting basic needs.
Although residents feel jobs are available, often times, income earned from employment isn’t enough to
meet needs. Many of the available employment opportunities often have a median wage below amount
needed for self-sufficiency ($15.90 hourly each for a family of 4, if both adults work). The greatest pro-
jected areas for job growth in the county are in industries that offer low wages, such as in the retail and
service sectors. Job opportunities will be available in higher wage jobs (e.g., nursing, skilled labor), but
these opportunities require additional training/education.
Many residents and experts agree that Collier County residents have a hard time finding affordable
housing. The average single-family home value in Collier County was estimated at $573,519, which
is much higher than the state average of $219,681. About 40% of Collier County residents qualify as
“housing-cost burdened”, meaning they spend at least 30% of their available income on rent or mort-
gage, causing them to make difficult choices involving cutting back on other basic necessities. High
housing costs can lead to poor housing conditions, which differentially impacts low-income residents.
This can result in substandard housing which is a concern in the Immokalee area.
The high cost of living is driven by the housing costs. There is a lack of affordable houses on the market
for sale and rent, and a lack of subsidized housing for the elderly and low-income resident. Community
members stated that the housing costs drive many middle class and lower-income residents (including
public service and service workers) to move to nearby counties and towns, like Lee and Lehigh, where
they spend the earnings they made in Collier County.
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Environment
Transportation and Infrastructure
There were several environmental concerns and issues raised by experts, including growth related
environmental impact on land and wetlands and storm water drainage concerns. Experts were also
worried that the focus on improving beach access and parking posed a threat to beaches. Finally, they
were concerned about the lack of focus on sea-level rise by community leaders. More education/aware-
ness on water quality, conservation and threats to the environment are needed for the general public
to fully comprehend the risks to environment and how these issues affect their communities. Residents
did voice concerns over pesticide and fertilizer pollution/runoff.
Most residents in Collier County commute using their own vehicles and very few use public transpor-
tation, citing lack of options. Those who have to commute long distances to work have an additional
transportation cost burden that can further impact quality of life. Traffic pattern fluctuations are sea-
sonal, with traffic worsening during the peak season. Experts predict traffic in the western areas of the
county will be above average until services in eastern parts of the county match the residential growth
in those areas. Residents in zip codes west of Collier Blvd and in the northern parts of the county were
most dissatisfied with traffic’s effect on their daily lives. Focus group participants raised concerns about
the lack of public transportation and the lack of safe walkable and bikeable pathways. However, results
indicated that multi-modal forms of transportation (i.e., biking and walking) are not equally supported
by the public; half of survey participants were satisfied with public transportation and felt that residents
had access to transportation, while the other half disagreed. According to expert participants, roads in
Collier County are at capacity, and more 4-6 lane roads are being built for a car-centric culture among
residents.
Overall, residents in Collier County were generally satisfied with the cleanliness of their community and
with the public space management. They believe that their communities are well-maintained (82%)
and that they have access to clean outdoor facilities (81%). They reported being satisfied with public
building maintenance (74%) and with maintenance of streets/roads (82%). This trend did not hold for
the communities of Copeland, Chokoloskee, Everglades City, Goodland, and Immokalee, who were
generally dissatisfied with the maintenance of their community. In addition, Copeland and Immokalee
were also less satisfied with their air quality, water quality, and green spaces.
10
Health Care
CEducation and Other Social Services
In general, parents were very satisfied with the quality of educational options. They felt that the avail-
able preschool and K-12 education programs are of high quality. However, parents in many areas of the
county cited a lack of affordable child care and preschool options, indicating that the quality options are
out of their budget. Additionally, residents cited that post-secondary options, including vocational train-
ing, were an area of need. In some instances, residents were aware of existing opportunities, but could
not take advantage of them due to transportation issues. Immokalee residents were concerned with
the lack of capacity in quality preschool and afterschool programs. Many residents in these areas turn
to unlicensed providers for this care if quality programs are unavailable. Residents in Immokalee were
also concerned with high teacher turnover, especially in the middle schools. With respect to elder care,
additional affordable assisted living facilities are needed to support and increasing elderly population.
Residents in Copeland, Chokoloskee, Everglades City, Goodland and Immokalee pointed to a lack of
social services for elderly residents.
Well-being and community Cohesion
Residents in Collier believe themselves to be mostly healthy, and the region exhibits a higher well-being
score than that of the state. Southwest Florida is a participant in the Blue Zones Project, “a community-
wide well-being improvement initiative” designed to “help make healthy choices easier” for Southwest
Florida residents. As a result of these efforts, the well-being index in Southwest Florida has been in-
creasing despite a reverse trend throughout the nation as a whole.
With regards to health care services, residents in Collier County voiced concerns related to primary
care provider (PCP) availability and wait times (especially during peak season and for Medicare/Med-
icaid recipients). The lack of PCP providers is of particular concern in the Immokalee area. While there
is a sufficient supply of dental care providers, residents are concerned with the affordability of services.
Residents are also worried about the lack of both mental health care and addiction treatment availabil-
ity. Though the number of providers has increased in recent years, gaps in services remain, especially
with respect to affordable assisted living options for residents with mental health issues. Community
members felt that income determined both the access and quality of care one receives. Some residents
voiced concerns regarding discrimination they experienced firsthand within the healthcare system. Un-
documented workers in agricultural areas are particularly concerned about access to services given the
current political climate surrounding immigration.
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Health and Healthy Behaviors
Recreation and Leisure
Generally, residents who do struggle with their health tend to have issues with chronic illness, sub-
stance abuse and obesity. Regarding alcohol and drug abuse, it is estimated that about one-fifth of
residents in Collier engaged in heavy drinking and a larger proportion of residents age 65 and over
engage in these types of behaviors than the state. Approximately 67% of respondents agreed that res-
idents in their community are generally more healthy. About half of participants indicated that residents
struggled with alcohol use, illegal drug use, and prescription drug abuse in their communities. All the
aforementioned health issues are of greater concern in the Immokalee area.
Community residents believe that they have adequate access to parks (84%), adequate access to
beaches (81%), and adequate availability of arts/cultural programming (76%). Residents expressed
concerns related to the affordability of recreational options. In general, Immokalee residents are more
likely to disagree with statements regarding access to recreational activities.
Safety
Collier County residents believe their communities to be largely safe and indicated that they were satis-
fied with emergency services. Residents are concerned with safety of pedestrians and bike riders, lack
of lighting at night for drivers, and texting and driving, though 73% of residents felt safe driving. Again,
Immokalee residents are more concerned with their safety than are most residents in Collier County.
While residents seem to be aware of the many opportunities for recreation that exist in the community,
many residents likely struggle with affordability and access to these activities.
12C Introduction
This CNA offers a portrait of Collier County and the needs
of its residents by presenting data on demographic and
socioeconomic characteristics, as well as an appraisal of
the economic, physical, service, and social environments
including the following ten domains: 1) Employment and
Economic Opportunity, 2) Housing, 3) Transportation/In-
frastructure, 4) Environment, 5) Health Care, 6) Education
and other Social Services, 7) Well-being and Community
Cohesion, 8) Health and Health Behaviors, 9) Recreation
and Leisure, (including Culture & the Arts) and 10) Safe-
ty. While this report illustrates specific community needs
that have an impact on residents’ everyday lives, it also
moves beyond specifics to provide a broader analysis re-
garding foundational issues that impact people’s quality of
life along with assets found within the county. The CNA
captures conditions in the local environment that contribute
to quality of life such as housing costs, access to health
care, places for recreation, and physical safety.
1.
2.
3.
Founded in 2004, the Richard M.
Schulze Family Foundation (RMSFF)
strongly believes that a good educa-
tion, a strong family, and a strong work
ethic are key for children and their fu-
ture. Committed to the families in Col-
lier County, Florida, the RMSFF pro-
vides funding to service providers and
nonprofit organizations that focus on
human and social services, education,
and health and medicine. In an attempt
to better understand the needs and is-
sues affecting the residents of Collier
County, RMSFF contracted with Q-Q
Research Consultants (Q-Q Research)
to design and implement a Community
Needs Assessment (CNA) for Collier
County, Florida.
The purpose of this CNA is to highlight the key issues faced by Collier residents in order to address
three primary objectives:
The intended audiences are people working to address a variety of community issues, including com-
munity organizations and civic leaders. RMSFF looks forward to joining with various community stake-
holders to work towards building a flourishing Collier County that can offer a quality life for all its resi-
dents.
Identify and quantify the conditions, needs, and assets of the community,
Analyze the access and delivery of resources to the county residents, and
Provide findings that will allow community leaders and members to de-
velop priorities and strategies to address identified needs and gaps while
utilizing and mobilizing existing resources.
13
Report Format
Identify and quantify the conditions, needs, and assets of the community,
Analyze the access and delivery of resources to the county residents, and
The report is organized into four principal sec-
tions: Introduction, Methodological Approach,
Collier County Snapshot, and Major Findings
and Community Identified Priorities. The Intro-
duction section provides a brief introduction to
the primary goals and objectives of the CNA
and describes the overall structure of the report.
The Methodological Approach section contains
key methodological details of the CNA, and the
Collier County Snapshot provides both a phys-
ical description of Collier County, along with a
demographic description of its residents. The
Major Findings and Community Identified Prior-
ities section presents the findings of the CNA
organized into five primary sections (Employ-
ment and Economic Environment; Physical En-
vironment; Service Environment; Social Envi-
ronment; and Community Identified Priorities).
These five sections are further divided into more
focused topical subcategories (e.g, Housing,
Environment, Transportation). Each subcatego-
ry presents data at the County level and features
disparities among subgroups if warranted (usu-
ally by zip code or race/ethnicity, but occasion-
ally by other subgroups). Not every disparity is
discussed; just because a disparity is not men-
tioned does not mean that disparity is non-exis-
tent or not important to address. Decisions were
made as to what to incorporate with respect to
disparities based on perceived importance by
community residents and stakeholders. Each
subcategory section ends with “Key Points” that
summarize central themes in order to help the
reader make sense of the data.
14
About the Data Disaggregation of data by
Smaller Geographic Regions
and Community SubgroupsA significant portion of the data in this report
comes from the Collier County Community As-
sessment Survey (CC-CAS). The CC-CAS was
developed by the research team in consulta-
tion with the RMSFF Community Assessment
Advisory Committee and administered to those
who live and work in Collier County. Addition-
ally, qualitative data was captured from 6 ex-
pert-led focus groups facilitated by the research
team, along with 16 volunteer led focus groups.
Altogether, the focus groups were attended by
122 residents and experts. Supplementary data
sources were included as well, through the as-
sessment of 37 prior reports. Preliminary results
were presented to the CNA advisory board and
to a selected group of residents in a focus group
format for feedback and recommendations pri-
or to final analyses. For ease of reading, the
source and year are included in the text when
the time frame is necessary for understanding
the data. Additionally, data was rounded to im-
prove readability. After a thorough review of all
available data sources through various ana-
lytic approaches, it was noted that in general,
findings were consistent across informants and
sources. When multiple data sources from var-
ied approaches yield similar results, confidence
in the accuracy and strength of the findings is
increased.1
Most of the data presented in this CNA are pre-
sented at the Collier County level or are disag-
gregated by zip code. Summaries focusing in
more detail on the community priorities disag-
gregated by zip code are included when avail-
able. In addition, brief summaries that address
the community priorities of unique populations
have been included. Occasionally data are dis-
aggregated by Planning Community, distinct re-
gions used by County agencies in the develop-
ment planning throughout the county. Finally,
the current CNA takes a look at resident needs
and priorities by race/ethnicity and socioeco-
nomic status to determine if certain groups are
at an advantage or at risk, or have better or
worse access to resources. Such an analysis is
essential for prioritizing the provision of assis-
tance efforts aimed at reducing and eliminating
disparities among particular subgroup popula-
tions.
15
Methodological Approach
In order to meet the key objectives of this CNA project, a comprehensive mixed-methods design was
adopted utilizing methods to collect qualitative and quantitative data from both primary and secondary
sources. Quantitative data was captured from the CC-CAS. Qualitative data was obtained from both
expert-panel focus groups which were facilitated by the research team, and from volunteer led focus
groups who were facilitated by trained volunteers. In addition to this, a series of secondary data sources
were analyzed in order to leverage existing information. The procedures and methodology employed
for data collection using each assessment method are described in the sections that follow.
To identify the primary foci of the CNA, and to gain a clearer understanding of stakeholder require-
ments for the needs assessment process, the research team facilitated a visioning session with the
RMSFF Community Assessment Advisory Committee. The session was interactive, which allowed the
committee to share their opinions related to the goals of the CNA. Results from this visioning session
guided Q-Q Research in developing key questions, and in defining the scope of the project to include
an appraisal of the following ten domains: 1) Employment and Economic Opportunity, 2) Housing, 3)
Transportation/Infrastructure, 4) Environment, 5) Health Care, 6) Education and other Social Services,
7) Well-being and Community Cohesion, 8) Health and Health Behaviors, 9) Recreation and Leisure
(including Culture & the Arts) and 10) Safety. Stakeholder participants identified the above as being
most important for the current assessment. In addition, participants suggested several subgroups of
residents as populations of interest including citizens that identified as low-income, rural, migrant work-
ers, permanent, transient, elderly, and mothers of young children. Guiding documents provided to the
Advisory Committee are attached to this report in Appendix A.
16
Community Engagement: Primary data
Goals
Community Surveys
1.2.
3.4.]]The goals of the community engagement component of the CNA were to:
The CNA utilized a community-based participatory approach allowing for feedback and input through-
out all stages of the CNA implementation. This approach empowered stakeholders to voice their expe-
rience regarding the needs of the community and ensured that the research team was in alignment with
the vision and purpose of the assessment.
RMSFF and the research team worked with community partners and volunteers to collect survey data
and host focus group meetings with target populations. Target populations were selected in consulta-
tion with RMSFF based on the following factors: 1) the population has known needs or disparities, 2)
more information regarding the needs of the particular population was needed, and 3) the population
was available through outreach involving an existing community group/agency. All data collection was
facilitated in the last half of 2017. Successful community engagement would not have been possible
without the contributions of several community partners.
The research team developed the CC-CAS using structured and open-ended questions that aimed to
gather the needs of the community. In order to quantify resident attitudes and perceptions regarding
their needs, questions were created using the information provided by stakeholders during the initial
visioning session. The survey consisted of four sections. The first section asked residents to agree or
disagree with statements regarding the existence of needs and services in their neighborhood related
to the domains specified above using a 4-point Likert scale. The second section asked residents to rate
their satisfaction using a variety of community services available to them also using a 4-point Likert
scale. The third section asked two open ended questions allowing residents to comment on what they
believe is their community’s greatest need and their community’s greatest strength. Finally, the fourth
section asked demographic questions that allowed the research team to make comparisons across
different population subgroups. The CC-CAS survey is presented for review in Appendix B.
Identify the needs of all
types of residents within
Collier County, including
those of special and vul-
nerable populations;
Obtain data on popu-
lations for which we
have little quantitative or
qualitative data; and
Build relationships be-
tween the community
and RMSFF.
Identify assets found
within Collier County;
17
Expert Led Focus Groups
Six selected focus group were led by expert researchers (referred to expert-led focus groups through-
out the report) to explore particular themes and issues along with the needs of unique populations more
in depth. The following themes were identified by the RMFSS Assessment Advisory Committee for in-
depth analysis via expert-led focus groups: Environment, Housing, Health Care, and Transportation/
Infrastructure. Additionally, expert-led focus groups were conducted with residents from the Immokalee
and Haitian communities. Each group included 7 to 10 participants identified by RMSFF staff. Partici-
pants were chosen due to their knowledge of the chosen topic (e.g., housing, safety) or because they
represent a stakeholder group in the community (e.g., older adults, parents of young families). Ques-
tions for the focus groups were informed by the quantitative survey topics. The guides for the expert-led
focus groups are presented in Appendix D.
The final approved CC-CAS survey was made available to Collier County residents in two formats: online
and paper-and-pencil. Any community member who works or resides in Collier County wishing to com-
plete the survey online was be able to do so. Participants were targeted using a stratified convenience
sampling approach using quota method, sampling by zip code. Specifics regarding sampling strategy
are presented in Appendix B. The research team worked with RMSFF staff to develop a comprehensive
list of locations in each zip code in order to determine preferred locations for paper-and-pencil survey
distribution. The research team trained several volunteers recruited by RMSFF to collect survey data.
These volunteers engaged residents in various locations to reach community members who may not
have access to, or feel comfortable with, an online version of the survey. Data collection began in July
2017 and ran through December 2017.
In total, 4,175 surveys were collected from people who live and work in Collier County. Participants
came from a variety of backgrounds. The ethnic groups with the largest representation were Cauca-
sian (53%), Hispanic/Latino (17%), and African American (4%). Other self-reported ethnicities included
Asian and Native American. Twenty-three percent of respondents declined to report ethnicity. Twen-
ty-six percent of participants were over 60 years of age. Approximately 28% of participants are parents
of children under 18. Fourteen percent of participants earned less than $25,000 per year and 23%
earned more than $100,000. The majority of participants were female (66%). Additional details regard-
ing survey sample demographics are available in Appendix C.
18
Volunteer Led Focus Groups
All expert-led focus group meetings were facilitated by the Q-Q Research team. Focus groups were
recorded and transcribed to ensure that information obtained was of high quality. Participants were
asked to identify the main issues related to each topic and who was most affected by these issues.
Participants were also asked what areas of the county were most impacted by each problem and what
actions were being taken to address these concerns. Specific information regarding the composition of
the expert-led focus group participants is available in Appendix D. Qualitative summaries of expert-led
focus group findings are available in Appendix E.
In addition to the expert-led focus groups described above, 16 additional focus groups were led by a
group of selected volunteers (referred to as volunteer-led focus groups throughout the report) to gather
additional qualitative data on Collier County needs and assets at the zip code level and from special
population groups. The volunteer-led focus groups included a total of 122 participants. The RMSFF
staff identified participants and convened the focus groups. The research team developed focus group
guides and trained the volunteers to facilitate the groups to ensure the standardization of delivery. A
description of the trainings is described in Appendix F. Ten focus groups were conducted in the follow-
ing zip codes: 34116, 34114, 34113, 34109, 34105, 34103, 34108, 34102, 34145,
34139, and 34119. A total of 68 residents participated. Six focus groups were con-
ducted with the following special population groups: persons with developmental
disabilities, young professionals, seniors, single mothers, members of the Semi-
nole tribe, and a group made up of teachers, first responders, and police. A total of
54 residents participated. Specific information regarding the demographics of
volunteer led focus group participants is available in Appendix F. Qualitative
summaries of volunteer-led focus groups disaggregated by zip
code and special population are available in Appendix G.
19
Assessment of Prior Reports: Secondary Data
1.2.
3.4.
An assortment of reports and assessments addressing issues of concern in the current CNA have been
completed by various agencies and community partners within Collier County. As such, we conducted
a review of the existing body of research and reports to guarantee a more robust and comprehensive
analysis. Many of the identified existing reports were provided by the RMSFF through cooperation with
community partners and county agencies. Others were gathered through secondary research methods
such as internet and database searches.
Reports in the analysis were included if they met the following selection criteria:
They included primary
data collected from orig-
inal sources within Collier
County or if they included
secondary data specific
to Collier County,
The methods of data
collection were dis-
cussed, and
The foci of the report
included one of the pri-
mary identified domains
examined in the current
needs assessment.
The data was collected
in 2010 or later, ]]In May of 2017, the Q-Q Research team was provided 38 reports for possible inclusion in the assess-
ment of prior reports. Data extraction and analysis included motivations for the reports, the identification
of community needs, as well as a depiction of the populations included. The assessment of prior reports
included existing assessments which engaged community partners and citizens, representing a com-
prehensive range of Collier County residents. Twenty-eight of these documents met our established
inclusion criteria stated above.
Document review was performed by Q-Q Research staff members. All reports were reviewed using
the document review checklist provided in Appendix H. A list of all documents reviewed is provided in
Appendix I. If a report met the aforementioned inclusionary criteria, a document review summary was
completed in full. For each report that met the inclusion criteria a data extraction form was completed.
20
Community Need IdentificationLimitations
There are a few methodological matters that
should be noted. The CC-CAS survey data dis-
played in this report represent raw/actual re-
spondent data. Consequently, among the limita-
tions of the survey are the self-reported nature
of the data. The quota sampling strategies used
allowed for reliable conclusions to be made re-
garding the needs of the county residents over-
all and with regard to comparisons at the zip
code level. Sample size limitations may have
affected the reliability of estimates for some of
the subgroup analyses with specific popula-
tions. As reports were identified by working with
RMSFF staff and through database and internet
searches, it is expected that not all eligible com-
munity reports and assessments were included
in the document review. This assessment of
prior reports includes all biases and limitations
that were fundamentally a part of the included
prior reports to begin with, along with those in-
troduced by the current methodology. As such,
findings should be interpreted with care and in
light of these methodological matters.
Finally, it is important to note that the CNA plan
was developed in the Summer of 2017 with the
input of RMSFF staff as described above. In
September of 2017, Collier County was hit by
Hurricane Irma, which severely impacted the re-
gion. An addendum was added to the CC-CAS
survey to assess the impact of the Hurricane on
residents. A brief description of those survey re-
sults is provided in Appendix J. Most surveys
and all focus groups were conducted after the
Hurricane came through the area. Some of the
hurricane impact is reported in the results that
follow, though it was not entirely possible to alter
the CNA plan to have captured the full extent of
the impact. The full impact of Irma is beyond the
scope of this report.
In order to determine the most appropriate way
to organize the vast amount of data gathered
from the multitude of sources described above,
the research team engaged in small group dis-
cussions about the data and developed a con-
sensus on the most prominent needs of the
community along with foundational issues.
Through this process, needs were identified
across the ten original domains and organized
into the following groups: Employment and
Economic Environment, Physical Environment
(e.g., Housing, Environment, Public Space and
Growth Management, Transportation), Ser-
vice Environment (e.g., Health Care, Education
and Social Services), Social Environment, and
Health and Well Being (e.g., Health and Health
Behaviors, Safety, Recreation/Leisure). Addi-
tionally, community priorities and foundational
issues were identified. Foundational issues are
needs which affect residents across multiple do-
mains and must be addressed to improve quali-
ty of life in Collier County.
Data describing the most prominent needs and
foundational issues are discussed in the Ma-
jor Findings and Community Identified Priori-
ties section of the report that follows and in the
appendices in greater detail. The key insights
gleaned from this report can be used by stake-
holders to make recommendations for collabora-
tive action that include objectives and strategies
to meet the needs of Collier County residents.
21
Collier County Snapshot
Map 1. Zip Codes: Collier County, Florida
Reprinted from: Community Development and Environmental Services
Division, Collier County, FL. (2005).
Retrieved from: http://www.colliercountyfl.gov.
Collier County, located on Southwest Florida’s gulf coast, is the 16th most populous county in the State
of Florida out of 67 counties. According to the U.S. Census Bureau, its 2016 estimated population is
365,136 residents, comprising roughly 1.8% of the state of Florida’s total population of approximately
20 million.2 In addition, the County estimates an additional 65,000 to 73,000 residents reside within the
area annually during what is known as peak season (October to April/May).3
Collier County encompasses 2,305
square miles and is the largest county
by land area (1,998 square miles) in the
State of Florida. Much of the southeastern
segment of Collier County is contained
within Big Cypress National Preserve,
designated to safeguard approximately
700,000 acres of swamplands in South
Florida. In addition, the southern coastal
segment of the county is contained with-
in the Everglades National Park, desig-
nated to protect the southern portions of
the Everglades wetlands.
The County offers a diversity of land-
scapes within its 3 municipalities (Na-
ples, Everglades City and Marco Island)
and several unincorporated communi-
ties. Communities range from dense-
ly populated coastal urban/suburban
neighborhoods to the sparsely populat-
ed rural/agricultural communities located
about 30 to 45 miles inland. See Map 1
for a visual presentation of zip codes in
Collier County.
22
Map 2. Planning Communities Collier County Florida
Reprinted from: Collier County Comprehensive Planning Section,
Collier County, FL. (2011).
Retrieved from: http://www.colliercountyfl.gov.
Collier County’s Planning Communities
Collier County has divided the region into 12 geographic areas called Planning Communities (PC) (Map
2). These distinct regions are used by County agencies in the development planning throughout the
county (Map 3).
Urban Planning Communities: 1 through 6, 10, and 12 are located in the western parts of the coun-
ty and include the cities of Naples and Marco Island. These planning communities are located mostly
west of State Road 951 (i.e., Collier Boulevard) and contain North, Central, East, and South Naples,
Golden Gate, Marco, and Urban Estates. Zip codes 34101 through 34113, 34116, 34119 and 34145
are located within these urban areas. The majority of land in these planning communities is zoned as
urban and contains land marked for estate or residential development, and planned unit developments.
The Naples Census County Division (CCD) encompasses several Census Designated Places (CDPs)
including the communities of Golden Gate, Island Walk, Lely, Lely Resort, Naples City, Naples Manor,
Naples Park, Pelican Bay, Pine Ridge and the Vineyards. The Marco Island CCD encompasses parts of
Marco Island City and Goodland. In addition, east of State Road 951, and contained within the bound-
aries the rural planning community of Corkscrew, is the planning community (and CDP) of Immokalee,
otherwise known as the epicenter of the county’s agricultural industry. Most of the agricultural workers
and migrant workers reside within its boundaries. The Immokalee CCD includes the Immokalee and
Orangtree CDPs. See Map 2 for a visual description of CDPs.
23
Urban Planning Communities: 7, 8, 9, and 11 are located inland in the eastern parts of the county
and include Everglades City. These planning communities are located mostly east of State Road 951
(i.e., Collier Boulevard) and contain Royal Fakapalm, Rural Estates, Corkscrew, and Big Cypress. Zip
codes 34137 through 34142, 34114, 34117, and 34120 are located within these rural areas. Rural Es-
tates and Royal Fakapalm are made up of residential regions to the west (closer to the coastal areas)
and agricultural/conservation areas to the East and South. The Everglades CCD is contained within this
area and is comprised of the CDPs of Chokoloskee, Plantation Island, Verona Walk, and Everglades
City. Corkscrew is at the northeastern end of the county and is mostly agricultural land. Finally, Big Cy-
press is mostly a conservation area and part of Big Cypress National Preserve.
24
Reprinted from: The Collier County Economic, Demographic &
Community Profile Growth Management Department Compre-
hensive Planning Section. (2016).
Retrieved from: http://www.colliercountyfl.gov
Map 3. 2010 Census Designated Areas in Collier County
According to the 2011 Collier County Eval-
uation and Appraisal Report (EAR), devel-
opment in most of the urbanized areas of
Collier County was at or past the 60% devel-
oped stage with the exception of Immoka-
lee (below 30%) and Marco Island (below
10%).4 According to the EAR, the County’s
master plan allowed for major urbanized
areas (within the urban planning communi-
ties) to establish infrastructure and services
in areas which were anticipated to have the
most growth. It is anticipated that several
of the urban areas within the county will be
further developed by the end of the decade.
Also noted in the 2011 EAR Report is the
considerable growth rate experienced by
the Rural Estates planning community when
compared to the other rural planning com-
munities. As such, there is a great need for
creating services and employment opportu-
nity growth within close proximity to areas
that experienced recent residential growth.
The population estimates in Collier as of
2017 (Figure 1) reflect that this trend has
continued to develop as approximately 90%
of the population is located within the urban
planning zones.
North Naples 57, 999
19,438
45,575
23,259
34,3335
1,918
17,086
36,635
12,738
25,112
242
45,476
Figure 1. Collier County Population by Planning Community: 2017 Estimates
Source: Collier County Comprehensive Planning Section. (2016).
Retreived from: http://www.colliercountyfl.gov
Urban Estates
Central Naples
Golden Gate
East Naples
South Naples
Marco
Royal Fakapalm
Rural Estates
Corkscrew
Immokalee
Big Cypress
25
Collier County’s Population Data
Age, Sex, and Other Characteristics
Between 2010 and 2016 the population in Collier County grew by 12.9% to 365,136, out pacing popu-
lation growth in Florida (9.2%).5 Collier is the 16th most populous county in State and by 2030, Collier
County’s population is expected to increase over 20% to approximately 441,995.6 All population data
discussed in the following sections was obtained from the 2012-16 American Community Survey 5-year
estimates unless otherwise noted. All data regarding population projections was obtained from the Uni-
versity of Florida’s Bureau for Economic and Business Research.
One of the most important population demo-
graphic characteristics to consider when plan-
ning for a community’s need is the age of its
residents. For example, a population in which
the demographic shift shows an aging popula-
tion may have increasing demands for health-
care systems and service needs as the popula-
tion continues to age. Conversely, a population
in which the demographic shifts show an influx
of younger residents may have increasing de-
mands for education and child care services.
The population of Collier County is considerably
older than that of the State of Florida (Figure
2). The median age of the residents of Collier
County was 49.2 years in 2016, while the medi-
an age of residents in the State of Florida was
41.6 years.7 Collier is the 9th ranked county in
Florida by percent of population ages 65 and
over.8
Approximately 5% the population is under the
age of 5, while 13.5% are between the ages of
5 and 17 (19.5% under 18). About 21.7% of the
population are between the ages of 18 and 39.
Sixty percent of Collier residents are over 40
years of age and about 29.6% are over the age
of 65. The median age of the residents over 65
is 74.5 years old.
26
The gender distribution in the County reflects that of Florida and the US as whole, with approximately
51% of the population being female and 49% being male.9 Of note is that the gender distribution varies
with respect to age (Figure 3). For residents under 40, males comprise a slightly higher percentage
of the population than females (52% vs 48%), while for residents over 40, females comprise a slightly
higher percentage of the population than males (52% vs 48%).
Figure 2. Population by Age Groups: Collier County vs. Florida
Figure 3. Population by Age Groups: Collier County Florida
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.govPercentage of PopulationFlorida
Collier County
5%
10%
15%
20%
25%
30%
35%
Under 5
Years
5 to 17
Years
18 to 24
Years
25 to 39
Years
40 to 64
Years
65 to 84
Years
85 Years
and Over
Under 5 years
35 to 39 years
30 to 34 years
15 to 19 years
80 to 84 years
5 to 9 years
45 to 49 years
50 to 54 years
60 to 64 years
70 to 74 years
75 to 79 years
55 to 59 years
20 to 24 years
40 to 44 years
85 years and over
10 to 14 years
65 to 69 years
25 to 29 years
Females
Males
0%2%4%6%8%
27
Demographic Shifts
The greatest population growth in Collier is expected to be among the 65-plus age group (Figure 4).10
The percentage of residents age 65-plus is expected to increase from 26.4% of the total population in
2010 to 32.5% in 2030 and 33.5% in 2040, with the majority of this increase among people age 80-plus.
In comparison, the percentage of residents 65-plus in Florida is expected to increase from 17.3% to
25.5% by 2040. At the state and national levels, the percentage of population 65 years and over has
also increased. When compared to the state, Collier county has a lower percentage of population under
18 years, but a higher percentage of population 65 years and over. At the same time, population pro-
jections suggest that the percentage of working-age residents (ages 25-64 years) will decrease from
47.2% of the total population in 2010 to 43.1% in 2030 and 42.4% in 2040.
2010 2020 2030 2040
Figure 4: Collier County Projected Population Growth by Age
40%
20%
60%
80%
100%Percentage of Projected Population Growth0-4 Years 5-17 Years 18-24 Years 25-64 Years 65+ Years
47.2%
6.9%
5.2%
7%6.8%
4.9%4.8%
6.5%
4.9%
26.4%
14.2%13.3%
45.9%
28.8%32.5%
43.1%
12.7%12.8%
42.4%
33.5%
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
28
Households with Children or Seniors
Of the 63,314 children under 18 that reside in Collier County, approximately 64% were living in married
parent households, with 36% of children residing in single parent households (25% being female led).
The median income of a married parent household with children was estimated at $69,127 while for a
single-parent household it was estimated to be between $36,730 and $30,466. Roughly 29% of chil-
dren are living in households that receive public assistance and 22% are living in households deemed
to be below poverty level. Eighty-eight percent of children were enrolled in public schools.11
Of the 10,342 residents that are age 65 and over, 57% live in married-couple family households where-
as 35.8% are living alone.12 Ninety percent of residents over the age of 65 hold at least a high school
diploma and 13.7% are employed, making up approximately 5% of the labor force. The majority of
these residents (91.7%) receive social security benefits, 46.4% receive additional retirement income,
while only 7.2% are below the poverty level. Moreover, 21.4% of elderly residents are civilian veterans.
At the county, state, and national levels, the percentage of population under 18 years old has been de-
clining while the percentage of population 65 years and over has been increasing (Figure 5). Compared
to state and national levels, in 2016, Collier County has had the lowest percentage of population under
18 years, but the highest percentage of population 65 years and over.13
29
15%
20%
25%
30%
35%
2012 2013 2014 2015
28.2%
18.8%17.6%
30.7%
2016Percentage of Total PopulationOver 65
Under 18
Figure 5 : Collier County Population by Age
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
30
Education
Race, Ethnicity, and Language
Approximately 85.7% of Collier County adult residents are high school graduates while 33.9% hold
Bachelor’s degrees or higher. Males are more likely to have less than a high school diploma than fe-
males (16.2% vs. 13.4%) but are more likely to have a bachelor’s degree or higher than females (37.8%
vs 30.3%).14
Though Collier County’s population is mostly White, the county has a very diverse population of res-
idents which has implications for the needs of the community. About 87.9% of residents identify as
White; 64.2% of residents identify as White only (non-Hispanic/Latino). Hispanic/Latinos (of any race)
represent the largest minority group (26.6 %) followed by Black/African Americans (7.0%) (Table 1).15
Total Population Percentage of County Population
Race Number Margin of Error Percentage Margin of Error
White 306,114 +/-1,902 87.9%+/-0.5
Black/AA 24,300 +/-647 7.0%+/-0.2
American Indian/Alaska Native 1,083 +/-293 0.3%+/-0.1
Asian 4,480 +/-261 1.3%+/-0.1
Other 8,297 +/-1,835 2.4%+/-0.5
Two or More Races 3,962 +/-689 1.1%+/-0.2
Ethnicity
Hispanic/Latino (of any race)9,751 **26.6%**
Mexican 39,224 +/-2,346 11.3%+/-0.7
Puerto Rican 7,112 +/-1,357 2.0%+/-0.4
Cuban 21,131 +/-1,860 6.1%+/-0.5
Other 25,284 +/-2,308 7.3%+/-0.7
Table 1. Race/Ethnicity and Population, Collier County
The rates of diverse populations are steadily increasing in the county. The Hispanic/Latino population
increased three-fold between 1990 and 2010 and the Black population increased two-fold during that
same time.16 As the total population continues to grow, net changes within racial/ethnic groups will con-
tribute to the county’s changing demographics.
The current state of this trend is demonstrated by examining the ethno-racial composition of Collier
County by age (see Figure 6 and Table 2). For the population ages 55 and up, White residents make
up more than 75% of the residents, while for the population ages 44 and under, White residents make
up less than half of the residents.
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
31
20%40%60%80%100%0%
Hispanic BlackMixed Asian OtherWhite
Under 5 years
35 to 44 years
30 to 34 years
15 to 17 years
75 to 84 years
5 to 9 years
55 to 64 years
20 to 24 years
45 to 54 years
18 to 19 years
85 years and over
10 to 14 years
65 to 74 years
25 to 29 years
Figure 6. Collier County Ethnic/Racial Composition by Age
Age White Hispanic Mixed Black Asian Other
Under 5 years 34.7%46.9%2.8%11.7%1.3%2.5%
5 to 9 years 37.1%45.7%2.4%9.5%1.7%3.5%
10 to 14 years 40.6%40.2%2.8%11.2%1.2%4.1%
15 to 17 years 44.5%38.4%1.7%10.3%1.2%4.0%
18 and 19 years 41.9%40.8%3.2%9.9%1.3%3.0%
20 to 24 years 43.0%39.7%1.7%10.5%1.5%3.7%
25 to 29 years 43.6%41.6%0.5%9.1%0.7%4.5%
30 to 34 years 42.9%41.6%0.8%9.1%1.6%4.0%
35 to 44 years 44.9%39.3%1.2%8.7%2.2%3.7%
45 to 54 years 60.1%27.3%0.7%7.3%1.6%2.9%
55 to 64 years 76.8%14.5%0.8%5.4%1.2%1.2%
65 to 74 years 88.7%6.7%0.4%2.9%1.1%0.2%
75 to 84 years 91.0%5.5%0.6%1.9%0.3%0.7%
85 years and over 93.9%4.1%0.1%1.5%0.3%0.2%
Table 2. Collier County Ethnic/Racial Composition by Age
Source: ACS 2012-2016 5 year Estimates
Retrieved from: https://factfinder.census.gov
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
32
Growth in the number of Hispanic/Latino, Black and multi-ethnic residents is expected to continue its
upward trend between now and 2040 (Figure 7).17 The White population will continue to grow in num-
bers, but will decrease as a percentage of the total county population. This ethno-racial growth trend is
moving in parallel to the trend expected statewide.
Figure 7. Projected Ethnic Composition by Percentage
Source: Population Projections By Age, Sex, Race, and His-
panic Origin For Florida and Its Counties, 2020–2045, With
Estimates for 2016 (2017).
Retrieved from: https://www.bebr.ufl.edu
2010 2020 2030 2040
40%
20%
60%
80%
100%
Non-Hispanic BlackNon-Hispanic White Hispanic/Latino
26.2%
6.6%7.5%8.1%8.6%
67.2%
30.7%
61.9%
33.5%
58.4%
35.3%
56.1%
Higher concentrations of specific ethno-racial populations exist in various geographic locations through-
out Collier County (Figure 8 and Table 3). These patterns are the product of a confluence of historical
events and present-day occurrences that reveal both positive and negative life circumstances.
In Immokalee, Naples Manor, and Golden Gate, residents are predominantly minorities; Immokalee’s
residents identify as primarily Black, while the primary minority groups in Naples Manor and Golden
Gate are Hispanic/Latino. Approximately half of Orangetree residents identify as minority (55%), Lely
Resort is one-third minority (33%), and Naples Park is approximately one-quarter minority (28%), with
Lely Resorts residents identifying as primarily Black, while the primary minority groups in Orangetree
and Naples Park are Hispanic/Latino. The remaining Census Designated Places and cities in Collier
are less than 10% minority.18
33
Age White Hispanic Black American
Indian Asian Other
Immokalee CDP 4.9%20.0%73.7%1.2%0.2%0.1%
Naples Manor CDP 6.1%75.5%18.4%0.0%0.0%0.0%
Golden Gate CDP 19.8%60.5%16.4%0.2%0.4%2.8%
Orangetree CDP 44.6%45.1%3.3%0.0%5.3%1.7%
Lely Resort CDP 66.4%10.7%21.1%0.2%0.7%1.0%
Naples Park CDP 72.5%23.9%1.0%1.2%1.3%0.1%
Verona Walk 88.7%5.0%0.0%0.0%4.2%2.1%
Pine Ridge CDP 89.0%9.1%1.5%0.0%0.0%0.4%
Marco Island City 89.8%8.7%0.2%0.0%1.1%0.2%
Naples City 90.3%4.1%4.5%0.1%0.4%0.7%
Everglades (City)92.2%7.3%0.0%0.0%0.4%0.0%
Island Walk 92.4%6.2%0.0%0.0%0.0%1.4%
Lely 93.4%5.8%0.4%0.2%0.0%0.2%
Vineyards 94.8%2.2%0.0%0.0%2.2%0.8%
Pelican Bay 98.1%0.9%0.0%0.0%0.9%0.1%
Goodland 100.0%0.0%0.0%0.0%0.0%0.0%
Chokoloskee 100.0%0.0%0.0%0.0%0.0%0.0%
Table 3. Minority Ethno-Racial Composition by Place, Collier County
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
Immokalee CDP
Naples Manor CDP
Golden Gate CDP
Orangetree CDP
Lely Resort CDP
Naples Park CDP
Verona Walk
Pine Ridge CDP
Marco Island City
Naples City
Everglades City
Island Walk
Lely
Vineyards
Pelican Bay
Goodland
Chokoloskee
Hispanic Black American Indian Asian Other White
Figure 8. Minority Ethno-Racial Composition by Place, Collier County
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
20%40%60%80%100%0%
34
Socioeconomic Characteristics
According to the MIT Living Wage Calculator, the required annual income before taxes for a family of
four (2 adults, 2 children) in Collier County is $66,340.19 This estimate takes into account food, child-
care, medical expenses, housing, transportation, taxes and the cost of living in the location. The living
wage estimate is discussed in greater detail in Section IV of the report. The median household income
in Collier County is $59,783(adjusted for inflation) and 53% of the eligible population is part of the labor
force (the unemployment rate is 6.4%). More than a quarter of the population (27.5%) has a household
income greater than six-figures (Figure 9).20
15%25%10%20%5%
15%
13%
13%
19%
24%
17%
$150,000 or more
$100,000 to $159,999
$75,000 to $99,999
$50,000 to $74,999
$25,000 to $49,999
Less than $24,999
Figure 9. Household Income Brackets, Collier County
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
35
The Federal Poverty Level (FPL) is commonly used measure to define poverty. The measure of income
is issued annually by the Department of Health and Human Services (HHS) and is regularly used to es-
tablish eligibility for public and social services. In 2016, FPL was $24,300 for a family of four.21 Thirteen
percent of Collier County residents (8.3% of families) earn less than 100 percent of FPL. Twenty-two
percent of children are living in households with income below the poverty level. Median income varies
by CDP and City (Figure 10).22
$0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000
Immokalee CDP
Naples Manor CDP
Golden Gate CDP
Orangetree CDP
Lely Resort CDP
Naples Park CDP
Verona Walk
Pine Ridge CDP
Marco Island City
Naples City
Everglades City
Island Walk
Lely
Vineyards
Pelican Bay
Figure 10. Household Income by Place and City, Collier County
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
36
Key Points ]]Collier County is geographically broad and home
to a diverse and growing population. There is
an obvious need for organizations and agencies
to provide services that adapt to meet communi-
ty needs that vary across the diverse landscapes
found throughout the County.
The County is becoming even more ethnically
and racially mixed. By 2040, the population will
be almost evenly split between majority and mi-
nority racial/ethnic groups.
The County’s population is aging. Over the next
decade, the need for health and social services
for an aging population and demand for elderly
care will increase.
There is a large income gap between the richest
and poorest residents of the county. Large seg-
ments of the population earn six-figures (approx-
imately 28%) while a considerable percentage (al-
beit a smaller percentage) live below the Federal
Poverty Level (approximately 17%).
37]MAJOR FINDINGS AND COMMUNITY
IDENTIFIED PRIORITIES
Employment and Economic Environment
Introduction
Income, net worth, and assets are essential elements that influence a person’s quality of life, their per-
ception of their own happiness, and their expectancies related to aging.23 Family income is correlated
with a person’s overall relationship satisfaction and has a direct impact on positive child development.24
In fact, Americans with a household income of less than $50,000 report being more likely to have
trouble paying for housing, healthcare, and are more likely to delay retirement. They also report being
less optimistic about both the present and the future. These effects operate in a stepwise fashion, with
middle-class Americans being better off than the poorest Americans, but being worse off than the upper
class, whose incomes are considerably higher.25 Research illustrates that a community’s employment
and economic conditions have a significant impact on quality of life, health, and on the differences
that exist among various groups.26 When families are faced with challenging economic conditions that
impede their ability to afford the basics, they are forced to cut costs, make tough decisions and take
risks.27
This section includes information on employment and the economic environment in Collier County
including data related to household income and assets, cost of living, how people in Collier County
are employed, the unemployment rate, and the labor market. The concerns shared by focus group
participants and survey respondents related to these issues are presented in the analyses along with
secondary data gleaned from prior reports.
38
Data
Income and Assets
The average annual and
weekly pay for Collier
Residents is below the
state average.
The median household income in Collier County Florida is $59,783, which is well above the state’s
average of $49,698 (both estimates adjusted for inflation). The median household income estimate is
comprised of all households in the County, and includes households with working and retired adults. In
addition to income, ownership of assets often contributes to economic stability. In Collier County, fewer
than 40% of residents own or have access to liquid assets (e.g., savings, retirement accounts, rental
income).28 These types of assets can be easily converted to cash to cover any financial emergencies
that arise. Over 90% of Collier residents own at least one vehicle. Vehicles are not typically considered
strong assets, as they depreciate over time. Over 70% of residents are homeowners, with a little over
half still being responsible for a mortgage. While owning a home can be integral for building wealth
over time, real estate cannot be easily converted to cash in the event of a financial emergency. While
the median household income is above the state’s median household income, the average annual pay
($45,448) and average weekly pay ($874) for residents in Collier County was below the Florida average
($47,035), meaning that on average, employed residents in Collier County make less annually than the
average Floridian.29
As stated in the Collier County Snapshot, more than a quarter of the population (27.5%) has a house-
hold income greater than six-figures, 12.5% of households earn between $75,000 and $99,999, and
18.8% earn between $50,000 and $75,999. Twenty-four percent of households earn between $25,000
and $49,999, while the remaining 17.3% earn less than $23,999 (see Figure 9, section III). Since 2011,
there has been a reduction in the percentage of aggregate household income from wages and salaries
and an increase in income from self-employment. In addition, there has been an increase in the percent
of household income coming from retirement and social security.30
39
Cost of Living
As cost of living in a community increases, lower income families may have difficulty meeting their basic
needs. According to Dr. Amy Glasmeier, Professor of Economic Geography and Regional Planning at
MIT, the “living wage” estimate can be used as an alternative to measure basic needs that provides
an approximation of cost elements in a basic household budget. This number represents the absolute
minimum employment earnings a household would need to maintain self-sufficiency. This estimate is
merely a step-up from poverty. Families that meet this basic threshold still live paycheck to paycheck
and cannot afford what many middle and upper class families consider to be necessities (e.g., eating
at restaurants, taking vacations/holidays, building savings/retirement funds).31 In most of the US, the
minimum wage does not provide a living wage for a typical family of four (two working adults, two chil-
dren). It is estimated, that two earners would need to work nearly four full-time minimum-wage jobs (a
75-hour work week per working adult) to meet the living wage threshold.32
According to the MIT Living Wage Calculator, the required annual income before taxes for a family of
four (2 adults, 2 children) in Collier County is $66,127. The living wage listed below is calculated based
on the hourly rate that an individual must earn to support their family, if they are working full-time. This
estimate takes into account food, childcare, medical expenses, housing, transportation, taxes and the
cost of living in the location. According to their estimates for a family of 4, if both adults are working,
each parent would need to earn $15.95 hourly in order to make a living wage. In a single parent house-
hold with 2 children, the parent would need to earn $29.33 hourly in order to make a living wage (Table
4). Minimum wage in Florida is $8.05 hourly. According to the estimates in Table 4, a minimum wage
salary would create a shortfall for households in Collier County.
Annual
Expenses 1 Adult 1 Adult, 1 Child 1 Adult,
2 Children
2 Adults,
1 Child
2 Adults,
2 Children
Food $2,983 $4,516 $6,722 $6,921 $8,888
Child Care $0 $7,818 $11,857 $7,818 $11,857
Medical $2,235 $7,282 $6,995 $6,995 $7,156
Housing $8,319 $12,317 $12,317 $12,317 $12,317
Transportation $4,401 $8,358 $10,918 $10,918 $11,911
Other $2,458 $4,008 $4,826 $4,826 $6,010
Required annual
income after taxes $20,396 $44,298 $53,635 $49,795 $58,138
Annual taxes $2,803 $6,087 $7,370 $6,842 $7,989
Required annual
income before
taxes
$23,198 $50,385 $61,005 $56,637 $66,127
Table 4. Income Needed for a Living Wage by Household Composition, Collier County 2016
Source: MIT Living Wage Calculator (2018).
Retrieved from: http://livingwage.mit.edu
40
Many of the basic costs of living listed in Table 2 are not taken into consideration – nor is location –
when calculating the Federal Poverty Level (FPL). It is important to note that this methodology has
not been updated since 1974.33 Alternate measures are necessary that wholly reflect families’ basic
needs and expenses while accounting for regional variation in cost of living. This regional variation is
particularly important in areas that have higher housing costs, such as Collier County. According to the
Economic Viability Dashboard, in 2012, Collier ranked poor in Housing affordability and fair in both job
opportunities and community support.34
One such alternate measure of income is the ALICE Threshold, or AT, developed by the United Way
in 2009. ALICE is an acronym for “Asset Limited, Income Constrained, Employed”. This acronym de-
scribes households that earn more than the aforementioned FPL, but less than the basic cost of living
for a given region or county. Using the AT measure along with the measure for FPL can provide a more
complete picture of the population struggling to afford basic needs in any given community. In other
words, ALICE households typically earn more than the FPL ($23,850 for a family of four) but less than
a living wage ($66,127 according to the MIT living wage calculator).35 As of the 2014 ALICE Report, it
was estimated that 10 % of families in Collier County were at or below the FPL, and an additional 24%
of households were below the AT, down from a combined 41% in 2012.
41
Employment and Labor Force
The economic recovery of the region has continued with employment and unemployment rates reach-
ing levels closer to normal long-term values.36 Since 2010, the unemployment rate has been declining
throughout the country. According to the 2012-2016 ACS 5-year estimates, the unemployment rate in
Collier County is 6.4% over that time period.37 In September of 2017, the Bureau of Labor Statistics
stated that the unemployment rate in Collier County to be 3.9%. This represents a marked improve-
ment from September of 2010 when the estimated unemployment rate was 12.5% for the county (see
Figure 11).
Figure 11: Labor Force and Unemployment: Collier County, 2005-2017
Source: US. Bureau of Labor Statistics (BLS). (2017).
Reprinted from: Collier County Economic Conditions Report (2017).
42
The labor force is defined as of the number of individuals 16 years and over available for work. A sig-
nificant percentage of residents in Collier County are not in the labor force (46.90%). This rate is higher
than the State of Florida rate (41.60%). This trend is likely due to the fact that many of Collier’s resi-
dents are of retirement age.36
While the population of 16 years and over increased by almost 30,000 from 2010 to 2016, the per-
centage of labor force decreased from 55.5% to 53.1%. Since 2010 more women have entered the
workforce (currently 47.8% are in the labor force and 44.6% are employed), and the percentage of two
parent households in which both parents are working has increased (62.3% of households with children
under 6 and 72.3% for children ages 6 – 17).37
According to the Collier County Economic Conditions report, employment opportunities in the County
vary by season. Unemployment peaks during the summer months of July and August as many of the
tourists and seasonal residents have left the area. Over the last few years, the difference between the
annual high and low unemployment periods has tightened, indicating the movement towards a more
stable, less seasonally-driven economy.38
From 2012-2016 in Collier County, most residents were employed in management, business, science
and arts occupations (Figure 12). The second most common employment category was service occu-
pations, followed closely by sales and office occupations.39
Production, transportation, and
material moving occupations
Natural resources, construction,
and maintenance occupations
Management, business, science,
and arts occupations
Service occupations
Sales and office occupations
24%
25%
30%
8%
13%
Figure 12. Occupational Categories
Source: ACS 2012-16 5-yr estimates
Retrieved from: https://factfinder.census.gov
43
From 2012-2016 in Collier County, most residents were employed in the education, health care, and
social service industries, followed closely by the arts, business, science and arts occupations (Figure
13). The next most common employment industry was professional occupations followed by the retail
trade, and construction industries.40
Figure 13: Industry Categories
Educational, Health Care, Social Assistance
Transportation, Warehousing, Utilities
Agriculture, Forestry, Fishing, Hunting, Mining
Retail Trade
Arts, Entertainment, Recreation, Accommodation
Wholesale Trade
Information
Finance and Insurance, and Real Estate
Public Administration
Construction
Professional, Scientific, Management, Admin.
Other Services, Except Public Admin.
15%10%5%
16.2 %
16 %
13.8 %
12.9 %
10.4 %
7.8 %
6.3%
3.7%
3.1%
2.6%
2%
1.5%
Source: ACS 2012-16 5-yr estimates
Retrieved from: https://factfinder.census.gov
44
Industry and labor market
The tourism industry in Collier County has remained strong. According to the Southwest Florida
Regional Economic Indicators Report published monthly by Florida Gulf Coast University, seasonal-
ly-adjusted tourist tax revenues increased 15% from 2016 to 2017. In addition, Collier County’s taxable
sales increased 7% from 2016 to 2017.41 Both of these indicators suggest an improving economy,
which should lead to an improved labor market.
The Labor Market in Collier County is considered to be diverse. The Florida Gulf Coast University In-
dustry Diversification Index (IDI), measured as part of its Industry Diversification Project, categorized
“the degree to which a region’s workforce is concentrated in few industries or dispersed into many”.42
The IDI for the Naples-Immokalee-Marco Island MSA (comprising all of Collier County) increased from
the previous year. In general, the area’s diversity index has been comparable to the IDI in the state and
is currently ranked as the most diverse of Florida’s 22 MSAs.43
In 2015, a research team at Hodges University published the Collier County Business Climate Survey
designed to ascertain the opinions of local business leaders with respect to business opportunity in Col-
lier County.44 The results of this study indicated that business leaders felt that the economic conditions
in the county and in their own respective industries were improving. The majority of business leaders
expected this trend to continue. Slightly over half of the sample projected an increase in employment
opportunities and almost all respondents expected either an improved employment market (or stable
employment market) in the next year. Slightly over half of the sample expected to expand their opera-
tions while a little less than half of respondents were concerned with the ability to obtain a sustainable
workforce.45
Annually, Workforce Now (a regional research initiative directed by Southwest Florida’s research uni-
versities) produces the Southwest Florida Workforce Overview Study.46 This report provides an over-
view of the most common employment opportunities available for residents by industry along with a
description of employment gaps and projected employment growth across industries.
According to their December 2016 report, the fastest growing industry in Southwest Florida between
2011 and 2015 was construction, which contributed to 50% of the increase in employment opportuni-
ties.47 It is projected that the fastest growing industries in the area of over the next few years will be in
health care and social assistance, followed by retail trade, construction, and accommodation and food
services.48
Furthermore, Workforce Now reported the top 10 occupations in which there was an existing employ-
ment gap in the region. A reprint of their analysis is included in Figures 14 and 15. Many of the em-
ployment gaps are in service industries and some require a HS diploma or less. Furthermore, wages
for these jobs are lower than would be necessary to meet the cost of living threshold in Collier County.
Jobs that require at least Vocational training or higher have median wages at or above the cost of living
threshold.49
Figure 14. Southwest Florida Workforce Overview Study: Short Term Employment Gaps
Reprinted from: Southwest Florida Workforce Overview Study. (2016).
Figure 15. Southwest Florida Workforce Overview Study: Short Term Employment Gaps, 2016
Reprinted from: Southwest Florida Workforce Overview Study. (2016).
45
Focus Group Reactions
Survey: Collier County Opinions
To further explore community sentiment regarding jobs and economic conditions, participants of ex-
pert-led and volunteer-led focus groups were asked questions focused on these issues. Both expert
participants and community residents in the focus groups perceived that there were not enough jobs.
Many agreed that low wages, low benefits, and high cost of living in Collier County were preventing
the community from being strong and diverse. Focus group participants stated that since many of the
County’s older population is seasonal, jobs also tend to be seasonal. Participants commented that this
was problematic for workers since there is no consistent stream of revenue coming in to their house-
holds, making it difficult to meet basic needs.
The CC-CAS survey also asked community members who live and work in Collier County questions fo-
cused on these issues. Respondents were asked if they believed that jobs were available for residents
year-round. Overall, a little less than half of respondents (48%) agreed or strongly agreed that jobs
were available year-round, with approximately 41% disagreeing or strongly disagreeing. About 11%
stated they did not know whether jobs were available for residents year-round (Figure 16a). In addition,
respondents were asked if they believe that residents in their communities made enough money to pro-
vide for their families. Only 34% of respondents strongly agreed or agreed with the above statement,
while over 53% of respondents disagreed or strongly disagreed with that statement (Figure 16b). Taken
together, while many in the community feel that jobs are available, a larger majority feel that despite job
availability, families do not make enough income to meet their needs.
46
22.7%
24.3%
3.9%
7.9%
41.2%
Figure 17. Satisfaction with Job Training Programs
Source: CC-CAS, Q-Q Research. (2017).
47
Furthermore, people were asked if they were
satisfied with their community’s employment
opportunities. Responses to this question
were very similar to the aforementioned ques-
tion regarding job availability, with about 48%
percent of participants indicating that they
were satisfied or very satisfied, and 34% of
participants indicating that they were dissatis-
fied or very dissatisfied.
Finally, people were asked if they were sat-
isfied with their community’s job training pro-
grams. (Figure 17). Many residents replied
that they did not have an opinion regarding
this issue. A greater percentage of respon-
dents who answered the question indicated
dissatisfaction with job training programs (ap-
proximately 31% were dissatisfied or very dis-
satisfied with only 28% being satisfied or very
satisfied). Altogether, many residents indicate
a lack of awareness of these programs, while
those who are aware indicate being more dis-
satisfied than satisfied with programming.
28.4%
41.4%
6.3%
12.8%
11%
Figure 16a. Jobs Available Year Round
Source: CC-CAS, Q-Q Research. (2017).
Don’t Know
Strongly Disagree
Strongly Agree
Agree
Disagree
32.8%
28.9%
5.4%
20.6%
12.2%
Figure 16b. Enough Income to Provide for Family
Source: CC-CAS, Q-Q Research. (2017).
48
Finally, in their projects, Workforce Now exam-
ined potential occupational growth by minimum
educational requirement (vocational training,
some college, bachelor’s or higher).50 The medi-
an wages for the half of the fastest growing voca-
tional occupations would be enough (or slightly
below) the median wage necessary to make a
living wage for a family of 4 ($15.90). These oc-
cupations included first line supervisors of food
preparation workers, carpenters, first line super-
visors of retail workers, maintenance and repair
workers and roofers. All of the fastest growing
occupations for individuals with some college
education, or with a bachelor’s degree or high-
er, have median wages above the median wage
necessary to make a living wage for a family of
4. Some examples of the fastest growing occu-
pations involving some college are Registered
Nurses, Construction Managers, Bookkeepers
and Accounting Clerks, Agricultural Managers,
and First-line supervisors of both trade and office
workers. Some examples of the fastest grow-
ing occupations involving a Bachelor’s degree
or higher include teachers across elementary
and secondary schools, accountants, manage-
ment analysts, lawyers, general practitioners and
physical therapists.51 Most of these occupations
make almost double the median wage necessary
for a living wage for a family of 4. These results
highlight the relationship between education and
jobs that pay a living wage.
Males Females
Educational Attainment Estimate Margin of
Error Estimate Margin of
Error
Percent
Difference
Population 25 years and over $33,688 +/-2,185 $26,864 +/-689 20.3%
Less than high school graduate $21,554 +/-849 $15,954 +/-938 26.0%
High school graduate (or equivalent) $29,471 +/-1,532 $22,114 +/-1,166 25.0%
Some college or associate’s degree $39,342 +/-3,706 $27,885 +/-1,730 29.1%
Bachelor’s degree $52,032 +/-1,892 $37,330 +/-1,975 28.3%
Graduate or professional degree $76,170 +/-6,573 $51,763 +/-5,568 32.0%
Table 5. Earnings by Education and Gender
49
Community Differences and Disparities
Income inequality in the county is a cause for concern. Collier County represents the second most
unequal metro area in Florida with respect to income according to 2013 ACS data. The top 1% in the
area makes 73.2 times more than the bottom 99%. According the Economic Policy Institute, the aver-
age income of the top 1% in Collier County is $4,191,055.52 The average income of the bottom 99% is
$57,258 (which is very close to the median income in the county). The ratio of top 1% income to bottom
99% income is 73.2 making it the 8th ranked county in the US with respect to income inequality. Only
Franklin County in FL has a wider income gap (ratio of 73.4).
Over the past 12 months, the median household income for families was estimated at $69,107, the me-
dian income for married-couple families is $80,979, while the median income for non-family households
was $39,346. Married-couple families were most likely to have household incomes above six-figures
(25%).53
Following national trends, the median individual salary of male, full-time year-round workers in Collier
County ($40,797) was greater than the median individual salary of female, full-time year round workers
($35,056).54 This wage gap is seen across levels of education (see Table 5).
Source: ACS 2012-2016 5 year estimates
Retrieved from: https://factfinder.census.gov
50
In 2012 – 2016, the following fields were occupied predominantly by males (> 70%): computer and
mathematics, architecture and engineering, firefighters, law enforcement, construction, maintenance,
farming, and transportation. During the same period, the following fields were occupied predominantly
by females (> 70%): education training and library, health practitioners and technicians, healthcare
support, office and clerical support.55
Hispanic and Black residents were more likely to be part of the labor force (72.4% and 52.3% respec-
tively). Black and Asian residents were more likely to be unemployed (15.2% and 11.2% respectively).56
Black and Hispanic households were more likely to be identified as below ALICE or FPL.57 As children
add considerable costs to a family (see Table 1), one would expect that many of the families in Collier
County that are below the FPL and AT have children. Most families with children in Collier County are
married, two parent households, and 31% of these households fall below these thresholds.58 Single
parent households are more likely to struggle, with 70% of single mother households and 62% of single
father thresholds falling below FPL and AT. Finally, educational attainment is related to FPL, with resi-
dents having less than a high school education being most likely to live below the FPL.59
ALICE and FPL also varied by community. The CDPs of Naples Manor, Immokalee, Golden Gate, and
Naples Park contained the highest percentage of households living below the ALICE and FPL thresh-
olds at 79%, 74%, 62%, and 51% respectively. The percentage of households below the ALICE and
FPL thresholds was between 25% and 38% in the following Cities and CDPs: Naples, Marco Island,
Lely, Lely Resort, Orangetree, Pine Ridge, and Verona Walk. The percentage of households living be-
low the AT and FPL thresholds was lowest in the CDPs of Island walk, Pelican Bay, and Vineyards at
16%, 16%, and 12% respectively.60
51
Focus Group Reactions
During focus group sessions, experts and community residents from Immokalee noted that most resi-
dents living in this area of the county work in service industries or in agriculture. They stated that many
undocumented families have stopped moving due to fear of being deported. Seasonal work fluctuations
have led to inaccurate resident counts, which result in fewer services than needed. Agricultural income
often fluctuates, making it difficult to make ends meet.
In addition, experts and community resident focus group participants commented on various issues
facing the Haitian community in Collier County. Participants recognized the key role played by The Hai-
tian Alliance for Collier County on job related issues. According to participants, many Haitians without
post-secondary education work in the service industry. Professionals face race discrimination in hiring
or are over-qualified for the jobs they obtain. More information about funding and business opportuni-
ties for Haitians is needed.
Within individual groups, Young Professionals (YPs), Single Moms (SMs), and the Teachers, Police,
First Responders (TPFRs) had concerns about their community’s employment and economic pros-
pects. YPs were concerned about a lack of jobs and the salaries and incentives to keep new and
mid-career professionals within the community.
52
Survey: Collier County Opinions
According to results of the CC-CAS survey, 69% of residents living in the following zip codes were
more likely to disagree or strongly disagree that jobs are available for residents year-round: 34137,
34138, 34140, 34142, and 34143. These zip codes correspond to the following communities: Cope-
land, Chokoloskee, Everglades City, Goodland, and Immokalee. In the same zip codes, only 13% of
residents agreed that residents in their community made enough money to provide for their families. It
should be noted the percentages of residents agreeing with this statement was lower than 50% across
all zip codes except 34134 (North Naples/Bonita Springs) and 33145 (Marco Island).
When asked about satisfaction with job training programs, 59% of residents living in the same group
of zip codes (34137, 34138, 34140, 34142, and 34143) were more likely to be dissatisfied or very dis-
satisfied with job training programs. Only 31% of respondents in these areas responded that they were
satisfied or very satisfied with services. ]
53
Key Points ]]When households do not earn a living wage, families are
typically forced to make tough decisions and forgo cer-
tain essentials choosing between health care or healthy
food, and/ may live in substandard housing in order to
survive, substantially impacting quality of life.
Given the cost of living in Collier County, and in light of the
fact that many households are below the FPL and ALICE
thresholds, the number of families not earning enough
to meet basic needs is cause for concern.
Creating opportunities for residents to earn a wage that is
equal to a living wage is key to improving the happiness
and quality of life of county residents. While unemploy-
ment is considerably lower than it has been in years, and
the economy is much improved, many of the available
employment opportunities in Collier County, both current
and projected, have a median annual wage below the
minimum amount needed for self-sufficiency.
Many of the employment opportunities that have a me-
dian annual wage at or above the amount needed for
self-sufficiency require at minimum, vocational training.
There is a lack of good paying jobs for those with a high
school diploma or less. In order to improve the quality of
life for many households, training programs and educa-
tional opportunities aligned with occupation growth in
higher paying occupations are needed.
54
Physical Environment
(Housing, Transportation/Infrastructure, and Environment)
Introduction
The physical environment of a community is also intertwined with residents’ quality of life.
Having a secure, affordable, non-transient place to live is considered a basic need that allows residents
to meet other basic needs.61 Where one lives determines access to employment, social services, educa-
tion, transportation and recreational activities, along with safety. In general, housing can be considered
an issue of supply and affordability. A high cost of housing can force middle and low-income residents
to cut back on basic needs (e.g., food, transportation, clothing and health care).62 High housing costs
often make it more likely for poorer residents to live farther from employment, community services, and
recreational activities. Long commutes to work can increase the cost burden on families even more.63
Affordable housing in Collier County continues to be a problem for many residents. As the population
in the county continues to grow, thoughtful informed growth management plans will be necessary in
order to create livable communities with a high quality of life for all classes of residents. This involves
adequate housing, transportation, and services, all while managing to conserve and protect the natural
resources and environment of the community.
55
Housing Affordability and Inventory
Data
Data presented below regarding housing affordability and inventory was obtained from the Florida
Housing Data Clearinghouse (FHDC).64 The FHDC used data from the U.S. Census Bureau’s 2010
Census Data, 2011-15 ACS 5-year summary data, and projections from the Bureau of Economic and
Business Research at the University of Florida.
The average single-family home value in Collier County was $573,519 in 2016. For comparison pur-
poses, the average single-family home value in the state was just $219,681.65 The average value
in the county for condominiums was $342,000, while mobile home value was $78,899. In 2016, the
median sales price for a condominium in Collier County was $255,000 and the median sales price
for a single-family home was $415,000. The statewide median sales price for a single-family home
56
was $212,000, less than the median sales price
for a condo in Collier County.66 In 2016, it was
estimated that just under 73% of households
in Collier County are homeowners. Residents
aged 15-44 are more likely to rent, while resi-
dents age 45 and up are more likely to own.67
For the remaining 27% of residents who rent,
median gross rent was $1,063 monthly in Col-
lier County in 2016, compared to $1,002 state-
wide.68 Rent prices vary according to the size
of the unit. According to the US Department of
Housing and Urban Development, fair market
monthly rent was as follows based on unit size:
a studio apartment: $801, one-bedroom: $973,
two-bedroom: $1195, three-bedroom: $1606,
and four bedroom: $1996.69 It is estimated that
8% of renters paid more than $1999 monthly in
2011-2015.70
Many residents in the community are concerned
with both housing affordability and inventory.
In early 2017, the Urban Land Institute (ULI)
completed an assessment of housing, land use,
and real estate issues in Collier County and pre-
sented their findings to the Board of Commis-
sioners in Collier County. In their assessment,
the researchers focused on housing cost bur-
den for families defined as the following:
Rent/Mortgage + Utilities + Taxes & Insurance
(if applicable) = Cost Burden.
If a household uses more than 30% of their in-
come on housing, they can be considered cost
burdened, if they use more than 50% of their
income on housing, they can be considered se-
verely cost burdened.71
In 2016, in Collier County, most households
were not cost burdened (60%), but 20.5% of
households were considered cost burdened,
and 19.5% of households are severely cost
burdened.72 These families are likely to have to
cut back on other basic necessities in order to
have a place to live. It is projected that while
the percentage of cost burdened households
57
will remain flat through 2025, the number of
households that are cost burdened is expected
to increase.73
As stated in the formula above, cost burden also
takes into account taxes and insurance. In Col-
lier County, flood insurance is often necessary
at additional costs. Homeowners insurance is
among the costliest in Florida and many com-
munities charge homeowner association (HOA)
fees.74 According to estimates from the AARP
Livability Index, housing costs and housing cost
burden in Collier County are significantly above
that for the median US neighborhood and in the
top third in the US.75
According to ULI, residents employed in the fol-
lowing sectors are most likely to be cost bur-
dened: public safety (e.g., firefighters, police
officers), health care (e.g., nurses, nursing/med-
ical assistants, senior care providers), education
(e.g. teachers & support staff), service work-
ers (e.g., wait staff, hotel staff, retail workers,
landscape, maintenance), and entry/mid-level
professionals (e.g., bank tellers, government
employees, administrative assistants). The ser-
vices provided by these residents are essential
for maintaining a safe, high-quality community.76
An additional area of concern noted in the ULI
report was the lack of housing for specific types
of residents in need. These groups include low
to moderate income seniors who have a lack of
independent and assisted living options, peo-
ple in need of residential mental health care
and support services, and very low-income res-
idents.77 There are fewer units of subsidized
housing in Collier County than for the median
US neighborhood.78
Furthermore, the ULI report discussed the avail-
ability and quality of housing units at the lower
end of the cost spectrum that may be available.
It was estimated in their report that approximate-
ly 8% of homes on the market in Collier County
58
Focus Group Reactions
in 2016 were occupied by residents earning less than the median income of the community, and the
vast majority of these units were condos.79
ULI presented a series of recommendations designed to improve the housing issues facing the county.
Their recommendations involved establishing a shared vision of Collier’s future and communicating
with the community to raise public awareness. These issues affect the entire community, not just the
neediest residents. ULI called for the community to increase the supply of affordable rental housing and
for the county to rewrite the land development code using several recommended strategies designed
to mitigate a multitude of identified issues. In addition, they recommended that the Affordable Housing
Trust fund be reactivated. Finally, they recommended enhancing the minimum wage in the county.
Other recommendations involved transportation. These issues will be discussed in the transportation
section that follows.80
These concerns were echoed by participants of an expert-led focus group held on the topic of hous-
ing. According to a panel of expert participants, 50% of the population of Collier County, including
homeowners and renters, is cost burdened. Most affected residents fall below 60 to 80% of the county
median income, including low wage earners, young professionals, and seniors who have outlived their
savings. Group participants stated that rental properties are largely unavailable, which lead many low-
er-income residents to move to nearby counties and towns, like Lee and Lehigh, where they spend the
earnings they made in Collier County.
They also echoed the concerns regarding a lack of subsidized housing. Experts believed that the lack
of subsidized housing is due to resistance to mixed-income development models, high development
taxes, impact fees, and regulations. According to group participants, even though tax credits are avail-
able to developers to build low-income housing, there is no incentive to build these units because
there is still a healthy market for expensive, single family homes in the county. This demand also works
against higher density housing plans. Experts also shared a concern that plans for low-income housing
in eastern Collier County could drive service workers further away from their jobs in Naples and other
areas to the west, creating different sets of struggles.
Related to lack of subsidized housing is the issue of housing quality for low-income residents. A main
concern among the community experts was the large number of substandard housing units, mostly
59
trailers, prevalent in poor areas of the county, such as Immokalee, where multiple families share a
home to save money. In addition, expert focus group participants felt that while housing issues of poor,
disenfranchised residents were not receiving enough attention by local government, some commission-
ers are starting to show more interest in working with advocates. Private employers are also starting to
show interest in housing financing solutions to attract needed service workers. According to one expert,
the ULI study referenced above has provided very useful data on housing issues, and is being widely
distributed. In addition, the local newspaper, Naples Daily News, has been focusing more on housing
issues in the county, raising awareness.
Issues related to housing costs and availability were also brought up by community residents during
the volunteer-led focus groups, analyzed by the Q-Q Research team. Every single focus group con-
ducted with community residents discussed housing issues. Participants agreed that finding affordable
housing in the area was nearly impossible for many. There was general agreement that service and
public-service workers had an incredibly tough time finding affordable homes or rentals within the
community, causing many of that population (and the middle-class workforce in general) to have to live
in neighboring communities and commute in for work. Many agreed that the low wages, low benefits,
and high cost of living were preventing the community from being strong with a diverse population of
residents.
]]SPECIAL ISSUE: Hurricane Irma’s Impact on Housing
According to expert participants, 60% of housing in Everglades City
has been condemned as a result of the storm; seniors and residents of
trailer home communities in East Naples and Immokalee were also very
affected. Assistance to re-build is not available for undocumented ag-
ricultural workers. Participants observed that seniors who qualify
for the State Housing Initiatives Partnership Program (SHIP) find the
application process to be cumbersome. Down-payment assistance to
prospective home owners is being re-allocated to cover disaster relief
costs. Another consequence of the hurricane will be the increase in
flood insurance costs for homeowners.
60
Survey: Collier County Opinions
The CC-CAS survey also asked community members who live and work in Collier County questions
focused on housing issues. Respondents were asked if they believed that affordable housing was
available for residents who needed it. Overall, only a quarter of respondents (25%) agreed or strongly
agreed that affordable housing was available for residents, with approximately 64% disagreeing or
strongly disagreeing. About 11% stated they did not know whether affordable housing was available
(Figure 18a). The results indicate that much of the community is aware of the issues discussed above,
but about 1/3 of the community is either not aware of the issue or doesn’t believe it is a problem. In
addition, respondents were asked if they were satisfied with the affordable housing options. Only 18%
of respondents strongly agreed or agreed with the above statement, while over 65% of respondents
disagreed or strongly disagreed with that statement (Figure 18b). Residents were also asked about
their satisfaction with utility services and waste management. Over 70% of residents were satisfied with
utility services, and 74% were satisfied with waste management services.
33%
20%
5%11%
31%
Figure 18a. Availability of Affordable Housing
Source: CC-CAS, Q-Q Research. (2017).
33%
15%
3%16%
33%
Figure 18b. Satisfaction with Affordable Housing
Source: CC-CAS, Q-Q Research. (2017).
Don’t Know
Don’t Know
Strongly Disagree
Very Dissatisfied
Strongly Agree
Very Satisfied
Agree
Satisfied
Disagree
Dissatisfied
61
Transportation Options and Traffic
According to the Collier County Economic Conditions Quarterly report, the County has seen an annual
growth of nearly 2% in traffic counts over the past 5 years.81 Researchers noted that traffic pattern fluc-
tuations are seasonal, with traffic worsening during the peak season. According to their analyses, many
of the main roadways in the urban western areas have already been expanded to capacity. The authors
note that the traffic in the county will be above average until the services offered in the east match the
population growth that has occurred in those regions. Over 85% of Collier residents drive to work (74%
drive alone and 11% carpool). Less than 3% take public transportation to work, while another 4% get
to work by other means. The remaining 7% of residents work from home. The average travel time to
work is 24.2 minutes.82 In general, residents depend on their own means of transportation to get to and
from most places.
In their assessment of housing affordability, the ULI also took note of the Housing + Transportation In-
dex. In general, when residents can’t find affordable housing in the areas in which they work, they move
further away to reduce cost burden. Though doing so decreases housing costs, it usually comes with
an increased transportation cost of 5 to 10%.83
62
Focus Group Reactions
Similar concerns were noted by participants of an expert-led focus group held on the topics of transpor-
tation and infrastructure. According to participants, the use of multimodal transportation, which would
involve building more pathways to include safe walkable and bikeable options, are not equally sup-
ported by the public. The cycling community, for example, is diverse (e.g., commuters, families, recre-
ational) and it is hard to find solutions to accommodate everyone. The widening of roads encourages
high speed, which result in car and pedestrian accidents. Heavy traffic is also a challenge to road and
pedestrian safety. Experts report that for those using public transportation, access to bus stops can be
challenging due to a lack of safe, walkable pathways.
These concerns were echoed during the volunteer-led focus groups attended by community residents.
Across the board, residents were concerned with the lack of public transportation options. Many be-
lieve that public transportation is dismal and could be strengthened. Residents feel, the existing public
system, CAT, caters to the hotel and tourism population rather than the locals due to the routes and in-
frequency of operation. It’s important to note that many seasonal workers do not have a driver’s license
making it very difficult to commute to and from work without adequate public transportation.
63
While the majority of res-
idents feel safe driving in
Collier County, the majority
are also dissatisfied with
traffic congestion in the
area.
Survey: Collier County Opinions
The CC-CAS survey also asked community members who live and work in Collier County questions
focused on transportation and traffic. Respondents were asked if they believed that residents in their
community had access to transportation. About 55% of residents agreed or strongly agreed, while 37%
of residents disagreed or strongly disagreed, that residents had access to adequate transportation. In
addition, respondents were asked if they were satisfied with the public transportation options. About
52% were satisfied or very satisfied with public transportation options, about 32% were dissatisfied or
very dissatisfied, and about 15% didn’t know. Responses to the above questions did not vary greatly at
the zip code level.
Respondents were asked if they believed that traffic in their community had an impact on their quality
of life. About half of respondents (50%) agreed or strongly agreed that traffic did have an impact on
quality of life, while 46% of residents disagreed or strongly disagreed with that statement. When asked
if the traffic congestion was problematic, 60% of residents were dissatisfied or very dissatisfied with
traffic congestion. Finally, 73% of residents agreed or strongly agreed that they felt safe driving in their
community. Responses to the above questions did not vary greatly at the zip code level with one excep-
tion. Greater percentages of residents (70%) in the western and northern parts of the county (zip codes
34102, 34104, 34105, 34108, 34109, 34119) reported greater dissatisfaction with traffic congestion.
This is consistent with the analysis completed in the Collier County Economic Conditions Quarterly
Report, indicating that traffic in the west will continue to be problematic until services in the east of the
county match the recent residential development in those areas.84
64
Growth Management and Public Space Maintenance
As previously noted, Collier County is one of the fastest growing counties in the state and 17th in the
nation. In order to ascertain perceptions of residents regarding growth management and public space
maintenance, the research team discussed these issues with focus groups and included questions re-
lated to these issues on the CC-CAS survey.
Planning for Growth: According to expert participants, Collier County is expected to grow at a 17.8%
rate between the 10 year period from 2010-20, placing it among the top 17 counties in the state for
growth. Some residents are showing interest in new forms of development, including mixed use options
affording more walkability and bikeability. The City of Naples is adopting a “Complete Street” plan which
could be expanded to the whole county. “Complete Street” plans sponsored by the Florida Department
of Transportation (FDOT) provide transportation options that serve the needs of various transportation
system users including pedestrians, cyclists, transit riders, motorists, and freight handlers.85 Partici-
pants agree that insufficient capacity of east to west corridors is a big problem. Road connectivity is
necessary, but is hindered by the proliferation of gated communities.
There is also agreement among experts on the need for accessible, reliable, convenient, and afford-
able public transit for service workers in the county, particularly in the east. But, participants felt there
is inadequate planning to include multi-modal transportation options that do not require the use of a
car and that diminish environmental damage. According to many in the group, the “not in my backyard”
mentality leads to opposition to county-wide transportation and traffic solutions. This results in missed
opportunities to place service structures closer to where people live, thereby reducing the need for lon-
ger distance trips that could reduce road congestion.
Expert group members noted that the public is often unaware of the potential impact of county devel-
opment and growth plans, likely due to the fact that information regarding potential impact is not readily
available and accessible to residents. More public education and communication are needed before
growth projects begin. In addition, they remarked that more transparency is needed from realtors in
disclosing growth impact on property values.
A series of miscellaneous issues related to growth were also raised by infrastructure experts. Among
these were insufficient beach parking for the general public and tourists (making beach access difficult),
and that drainage systems and canals in the county are antiquated and undersized to accommodate
growth.
Focus Group Reactions
65
Funding: Expert group participants agree that there is a lack of diversified funding sources for trans-
portation and insufficient funding to cover existing needs. Gas taxes, the main source of funding for
transportation and infrastructure, have been capped for a long time and revenue is going down. Ac-
cording to the experts, many projects (e.g., those in the watershed management plan) have no funding
allocated to them. Participants believe that available funding needs to be prioritized, and maintenance
expenses need to be included in future growth budgets.
On the positive side, experts noted that there are over $300 million dollars programmed in the MPO-
DOT plan over the next five years for projects in Collier County. The county is also looking at new sourc-
es of future funding, including a ballot initiative to consider a sales tax that could help ease the backlog
of new roads needed. Group members feel legislators would benefit from more education about the
realities on the ground in order to make more informed decisions.
66
Survey: Collier County Opinions
The CC-CAS survey also asked community members who live and work in Collier County questions
focused on public space maintenance and growth management. Respondents were asked if they be-
lieved that the residences of their community were well-maintained. A little more than 82% of residents
agreed or strongly agreed that their community was well-maintained. In addition, respondents were
asked if residents in their community had access to clean outdoor facilities. A little more than 81% of
residents agreed or strongly agreed with this statement. When asked if they were satisfied with public
building maintenance in their community, approximately 74% of residents indicated that they were sat-
isfied or very satisfied with this issue. About 82% percent of residents indicated that they were satisfied
or very satisfied with the maintenance of streets and roads. Differences in responses at the zip code
level will be discussed in the community differences and disparities section below.
Overall, residents had more mixed opinions with regard to growth management. About 44% of residents
indicated that they were satisfied or very satisfied with their community’s growth management, while
36% of residents were dissatisfied or very dissatisfied. About 20% of the respondents replied that they
didn’t know whether or not they were satisfied or dissatisfied with growth management (Figure 19). Re-
sponses to the question regarding growth management did not vary significantly at the zip code level.
23.7%
38.4%
6%
19.5%
12.5%
Figure 19. Satisfaction with Growth Management
CC-CAS, Q-Q Research (2017).
Don’t Know
Very Dissatisfied
Very Satisfied
Satisfied
Dissatisfied
67
More than half of the land in Collier County (68%) is designated as conservation land. Collier County
developed a conservation plan that involves growing in the community while preserving the natural
environment. Given the recent and projected growth, many residents have growing concerns related
to the impact on the environment. The research team discussed these issues with focus groups and
included questions related to these issues on the CC-CAS survey.
Growth Related Impact: According to expert participants, roads in Collier County are at capacity, and
more 4-6 lane roads are being built for a car-centric culture among residents. High traffic volume affects
residents’ quality of life, and negatively impacts wildlife habitats. Advocates feel that a focus on beach
access and parking overlooks the threats to beaches’ natural carrying capacity. The group feels high
density urban plans are not popular among developers who favor single family homes and golf courses.
Under the leadership of the City of Naples, the city is starting to attract new residents looking for more
walkable and accessible communities without relying on cars; and developers are starting to respond
to their wants. Experts feel density also benefits traffic and wildlife habitat preservation. Planning for
new, mixed urban designs would require changing zoning regulations and support from politicians who
are not yet fully on board. Advocates applaud the county’s set aside of 25% of residential development
land for native habitat preservation, but see it endangered by developers favoring growth over natural
preserves. Group participants point that developments built on low lands and flood plains are using fill
to raise the property, which raises concerns over depleting natural drainage areas and worsening the
danger of flooding.
Water related issues: Storm-water drainage issues are a high concern for this group of experts and
advocates. They point out that water could be re-used and distributed more effectively instead of being
returned to the Gulf. According to participants, saltwater intrusion due to lower aquifer levels and sea
level rise is getting worse, and the need for water desalinization will increase. Sewage connections to
main lines from new developments further away are needed; rural areas rely on wells for drinking, and
have no septic systems. Flooding is a big issue in Golden Gate Estates. Pesticides and animal waste
runoffs and other toxic waste are contaminating drinking water and the Gulf. Collier residents have high
water use to irrigate lawns and golf courses, and permitting agencies are over-allocating water permits
to new development. Some promising initiatives around water quality include a watershed manage-
ment plan adopted in 2011, including positive structural and operational elements and discussions of a
small water utility fee based on usage.
Environment
Focus Group Reactions
68
Wildlife: To these expert advocates, loss of habitat, on land and wetlands, due to development is the
major issue. Uplands are serving as refuge to lowland species extricated by development, but there
needs to be a balance between them so they can function well. Pythons in the Everglades and feral
cats in urban areas are a threat to other species. Group participants felt very strongly that human needs
have to be balanced against animal needs.
Advocacy: Experts noted that the county has many environmental groups and activists who are work-
ing with landowners on the issue of growth management in eastern rural areas. While non-profits do a
good job educating school age children about environmental issues and conservation, more education
is needed. Experts and advocates in the group feel that adult residents, developers, and politicians also
need more education on water quality, conservation, and threats to the environment.
Sea level rise: Finally, experts noted that the Southwest Florida Conservancy has a task force devel-
oping recommendations to the board on this issue. Contingency plans are needed for the county, but
there is no current political debate on sea level rise. They noted that the study is currently being con-
ducted on this issue and that county commissioners have expressed interest in their future findings.
69
Survey: Collier County Opinions
The CC-CAS survey also asked community members who live and work in Collier County questions
that focused on the environment. Respondents were asked if they believed that people and wildlife
successfully co-exist in their community. A little more than 65% of residents agreed or strongly agreed
with the above statement, 24% disagreed or strongly disagreed. In addition, respondents were asked
if they believed that in their community, the environment was being protected while managing growth
(Figure 20a). A little more than 56% of residents agreed or strongly agreed with this statement, while
33% disagreed or strongly disagreed. When asked if beaches, rivers, and estuaries had clean water,
approximately 65% of residents indicated that they agreed or strongly agreed, while 27% indicated that
they disagreed or strongly disagreed. Approximately a quarter of residents are concerned with environ-
mental issues in their communities.
When asked if they were satisfied with available services related to environmental awareness, a little
more than half the respondents (55%) indicated they were satisfied or very satisfied with this issue,
26% indicated they were dissatisfied or very dissatisfied, while 19% said they did not know (Figure20b).
Finally, residents were asked if they were satisfied with their community’s air quality, water quality, and
green spaces. Most respondents indicated that they were satisfied or very satisfied with their com-
munity’s air quality (87%), water quality (72%), and green spaces (70%). Differences by zip code are
discussed in the sections that follow.
21.5%46%
10.2%
11.4%
10.9%
Figure 20a. Environment Protected during Growth
Source: CC-CAS, Q-Q Research (2017).
Figure 20b. Satisfaction with Environmental Awareness Services
Source: CC-CAS, Q-Q Research (2017).
19%47%
8%
7%
18%
Don’t Know
Don’t Know
Strongly Disagree
Very Dissatisfied
Strongly Agree
Very Satisfied
Agree
Satisfied
Disagree
Dissatisfied
70
Community Differences and Disparities
The housing and property conditions in the Immokalee community have been significantly poorer than
the conditions in the county as a whole. According to the Immokalee housing study, overall housing
and property conditions have improved significantly in Immokalee since 2004, but still remain problem-
atic. As of 2010, 86% of the available housing was evaluated to be in “standard condition” compared
with 57% in 2004.86 According to the evaluation, improved conditions were related to better code en-
forcement, a site improvement plan process that was developed for mobile home parks, the existence
of new units, coupled with efforts focused on rehabilitating the community’s housing market, increased
number of new units, and major efforts by nonprofit organizations that have repaired and rehabilitated
many housing units in Immokalee. The report indicated considerable efforts would be necessary to
maintain improvements and to address the housing that was still considered sub-standard.87
The CDP of Immokalee has been designated as an area within the Southwest Florida Promise Zone.88
Primary goals of the promise zone initiative are upgrading water and wastewater systems, public tran-
sit, roads and street lights throughout the region. In addition, sidewalks are needed for residents to
safely connect with each other.
An expert-led focus group was conducted with Immokalee residents. According to group participants,
a shortage of low-income housing and too many regulations and requirements force poor families to
live in dilapidated housing (mostly trailers) owned by landlords who lack concern for tenants, the neigh-
borhoods, and the community interests. Rent abuse and overcrowding are prevalent in their commu-
nity. Many families do not meet the requirements for low-income housing, like the housing available in
Habitat Village, but still cannot afford suitable housing. Horizon Village provides affordable housing for
single agricultural laborers, but many choose not to live there due to strict rules and regulations.
In addition, an expert-level focus group was conducted with residents that are part of Collier County’s
Haitian community. According to group participants, poor Haitians are affected by the high housing
costs and shortage of affordable housing in Collier County. Many members of the Haitian community
who work in service industries live in Lee County or the town of Lehigh and work in Naples. They feel
that low-income housing is not welcome in many communities. The group also agreed that there is
inadequate public transportation for low-income working residents without cars. Buses take too long,
routes are limited, and stops are not safe. CAT buses provide some service, but the demand is greater
than the supply.
Focus Group Reactions
Copeland, Chokoloskee, Everglades City,
Goodland and Immokalee
have different opinions on
Environmental
Maintenance
than the rest of Collier County.
71
According to results of the CC-CAS survey, only 38% of residents living in the following zip codes
agreed or strongly agreed that their communities were well maintained: 34137, 34138, 34140, 34142,
and 34143. These zip codes correspond to the following communities: Copeland, Chokoloskee, Ever-
glades City, Goodland, and Immokalee. This represents a 44% difference from the 82% of residents in
the county overall who indicated that their communities were well maintained. In the same zip codes,
only 38% of residents agreed that residents in their community had adequate access to clean outdoor
facilities, as compared to 82% of the county overall. In the same zip codes, when asked if they were
satisfied with public building maintenance in their community, approximately 38% of residents indicat-
ed that they were satisfied or very satisfied with this issue, as compared to 74% of the county overall.
About 45% percent of residents in these zip codes indicated that they were satisfied or very satisfied
with the maintenance of streets and roads, as compared to 82% of the overall county.
Residents in 34137, 34138, 34140, 34142, and 34143 were about 10% more likely to state that they did
not know if people and wildlife successfully co-existed in their community or if the environment was be-
ing protected while managing growth. Their rates of disagreement were generally similar to the county
as a whole.
In 34137 (Copeland) and 34142, 34143 (Immokalee) residents were more likely to disagree or strongly
disagree when asked if beaches, rivers and estuaries had clean water; only 34% of residents indicated
that they agreed or strongly agreed (as compared to 65% in the overall community), while 49% indicat-
ed that they disagreed or strongly disagreed. Approximately half of the residents are concerned with
clean water issues in these areas. Finally, residents in these 3 zip codes were less satisfied with their
community’s air quality, water quality and green spaces. Fewer respondents indicated that they were
satisfied or very satisfied with their community’s air quality (60%), water quality (55%), and green spac-
es (45%) (as compared to 87%, 72%, and 70% respectively in the overall community).
Survey: Collier County Opinions
72
Key Points
]Essentially 40 % of Collier County residents qualify as
“housing-cost burdened”; those who are paying more
than 30% of their monthly income on rent or mortgage.
High housing costs can lead to poor housing conditions,
which differentially impacts low-income residents. This
can result in substandard housing which is a concern in
the Immokalee area.
Housing costs are a major component of the overall
cost of living for individuals and families in Collier Coun-
ty, where housing costs are high. The availability of af-
fordable rental housing options has an impact on the
quality of life of lower-income families.
Most residents in Collier County commute using their
own vehicles and very few used public transportation,
citing lack of options. Those who have to commute
long distances to work have an additional transporta-
tion cost burden that can further impact quality of life.
73]According to expert participants, roads in Collier County are
at capacity, and more 4-6 lane roads are being built for a
car-centric culture among residents. High traffic volume
affects quality of life of residents and negatively impacts
wildlife habitats.
There are several environmental concerns and issues
raised by experts, including growth related environmental
impact, water quality concerns, and sea-level rise. Residents
could use more education on how these issues affect their
communities.
Overall, residents in Collier County were generally satisfied
with the cleanliness of their community and with public
space management. This trend did not hold for the com-
munities of Copeland, Chokoloskee, Everglades City, Good-
land, and Immokalee, whose residents were generally
dissatisfied with the maintenance of their community. In
addition, Copeland and Immokalee were also less satisfied
with their air quality, water quality, and green spaces.
74
Service Environment
(Health Care, Education, and Social Services)
Introduction
Access to comprehensive and high-quality medical care are essential to ensure optimal health. In order
for an individual to obtain this type of care, a person must know how to access the health care system,
they must be able to get to the location where services are provided, and they must find a provider who
they can trust and communicate with.89 Common barriers to accessing the system include a lack of
provider availability, high cost of care, and a lack of insurance coverage. Inadequate insurance cover-
age is highly correlated with failure to receive necessary medical care. When health care services are
delayed or not received, residents have unmet health needs that can lead to preventable illness and
hospitalization. In addition, patients face preventable hospitalizations, delays in receiving care, inability
to get preventive services, and other unmet health needs.90 While oral health is separate from general
health care insurance coverage, oral health is also vital to one’s health. Good oral health is related to
disease prevention (e.g., gum disease, oral cancer).91
For most individuals, a primary care provider (PCP) represents an initial point of contact for most med-
ical issues.92 Access to a PCP is essential to improve health outcomes, especially those associated
with chronic conditions that require the implementation of management strategies (e.g., diabetes, heart
disease). As such, a critical component for a community to be healthy is an ample supply of PCPs for
the population. In fact, adequate PCP to population ratios have been associated with improved health
and lower rates of infant mortality and with lower rates of mortality from conditions such as heart dis-
ease and cancer. Communities with a greater focus and emphasis on primary care have fewer health
disparities and better health outcomes for residents.93
Educational status is strongly correlated with population health sta-
tus.94 Educational attainment is associated with well-being, health
related knowledge and healthy behaviors, income and employment
status, and a host of social and psychological factors. The benefits
of an education exist at various levels including the individual level
(e.g., individual skill building) and the community level (e.g., impact
of an educated workforce on community well-being). Schools and
other educational and social services play a major role in the over-
all development of a community and function to improve the lives
of children and adults.95 Schools, along with educational and other
social service programs, seek to improve resident’s lives by edu-
cating them and by providing them with proper nutrition and other
amenities required for healthy living.
75
Data
In 2016, there were 232 primary care physicians (PCPs) and 357 mental health care providers (MH-
CPs) operating in Collier County. Since 2013, the number of PCPs has increased 8% and the number of
MHCPs has increased 320%. In the same year, the ratio of PCPs to population was 1433:1 (compared
to the state’s ratio of 1387:1) and the ratio of MHCPs to population was 977:1 (compared to the state’s
ratio of 689:1).96 Although the ratio of PCP providers to residents is higher than that of the state, Collier
County has a PCP provider shortage for the Immokalee/Everglades service area.97 As of September
2016, a total of 80 registered “Health and Mental Health” nonprofit organizations were registered in
Collier County. The percentage of non-profits listed as health or mental health was only 5.2%, which is
lower than the rate for the State of Florida.98
In 2016, it was estimated that 58,901 residents (or 16.2% percent of the total resident population) in
Collier County were uninsured.99, 100 This is an improvement from 2010 in which 23.2% were uninsured.
Health insurance rates vary by age and gender. Males are more likely to be uninsured than females
(except from ages 18 to 24) and working age adults (ages 18-64) are more likely to be uninsured than
children or the elderly (Figure 21). Males ages 25-34 are most likely to be uninsured. It was estimated
that approximately 16.5% of residents in Collier County could not see a doctor due to costs.101
Health Care Services and Health Insurance
10%
20%
30%
40%
50%
Figure 21. Percentage of uninsured residents in Collier County (Health Insurance), 2016
Source: 2016 ACS 1-year Estimates
Retreived from: https://factfinder.census.gov
Under 6
Years
6 to 17
Years
18 to 24
Years
25 to 34
Years
45 to 54
Years
35 to 44
Years
65 to 74
Years
55 to 64
Years
75 Years
and Over
Males
Females
76
In 2016, the Collier County Community Health Assessment (CC-CHA) was conducted by the Florida
Department of Health in Collier County. The report included an assessment of community needs as
they related to the local public health system. The CC-CHA engaged residents in focus groups and
surveys to assess the needs of the community related to health and health care. Key findings from this
report are presented in the paragraphs that follow.102
According to the CC-CHA, private health insurance coverage is a necessity for working Americans
ages 18-64 in order to have adequate access to affordable medical care.103 With the recent changes
to the law involving the Affordable Care Act (ACA), the uninsured rate in Collier County and in Florida
has been decreasing steadily. With the uncertainty surrounding the future of the ACA, it is unknown as
to whether this trend will continue or reverse.
The CC-CHA discussed needs and gaps in the Collier community with respect to health care. There
is a movement of PCPs in Collier County to become concierge providers.104 Concierge providers ask
patients to pay an annual retainer (usually between $1,500 – $5,000) which is not covered by insurance
carriers.105 This allows patients direct access to their physician, with many extra benefits. Due to the
highly personalized nature of the practice, most concierge medical practices limit their patient base.
This trend is creating an access issue within the community. In addition, residents experience long wait
times to see a physician during peak season. The assessment reported limited access to women’s re-
productive healthcare services.
For low-income residents, transportation barriers may limit healthcare access. The authors noted that
the administrative burdens of Medicare resulted in a reduced number of PCPs that service Medicare/
Medicaid recipients. The study also reported a shortage of beds in long-term care facilities for Medicare/
Medicaid recipients. Finally, the ER is often used in lieu of a PCP based on its 24-hour availability.106
In addition to the above, the CC-CHA reported that the community was well aware of the need for more
mental health services and pointed to a gap in services with respect to mental healthcare. As stated
previously, statistics indicated over a 300% increase in the number of mental health providers in Collier
County from 2013-16.107 Despite that increase, ratios of providers are below state and national aver-
ages. With regard to assisted living facilitates, there is more of a market in the community for high-end
assisted living facilities, despite the growing need for affordable long-term care assisted living facilities
for middle and low-income residents.108
Regarding oral health, the CC-CHA stated that the number of dentists in Collier County increased by
almost 60% over a 10-year period ending in 2013. However, the majority of dentists are in private prac-
tice. Of note, was the lack of dental care options for low-income adults. Lower-income adults lacked the
resources to secure preventative dental services and often used emergency room services for emer-
gency dental care.109
80% of participants in these Focus
groups believed that mental health
and substance abuse issues are
major public health problems.
77
Several concerns raised in the CC-CHA were echoed by participants of an expert-led focus group held
on the topic of housing. These experts discussed issues related to health care affordability and accessi-
bility, mental health and substance abuse care, community prevention, and public health improvement.
With regard to health care affordability and accessibility, experts stated that most children in Florida
have health coverage through KidCare, and Federally Qualified Health Care Centers (FQHCs) offer
affordable medical care, dental, eye care and mental health services to children in Collier County.
Through a unique program, NCH health care system, which encompasses the largest local hospital and
several specialized health care centers, has placed nurses in all schools and uses tele-medicine, shar-
ing costs with the school system. Also, the program provides trainers for sport teams in high schools.
Group participants felt that access to pediatric specialists, however, is limited, and for working parents,
getting time off from work to take children to doctor’s appointments is a challenge.
Older, low-income adults have adequate Medicare and Medicaid coverage. According to the group,
some seniors still face coverage gaps when it comes to skilled residential care. There is a shortage of
beds in these types of facilities. The lack of assisted living facilities (ALFs) discussed previously with
respect to housing is also a healthcare concern, as ALFs provide housing and health care. Recently,
Hurricane Irma revealed a shortage of shelters and inadequate infrastructure to care for older adults
with medical needs in residential placements during emergencies. The health experts stated that out-
side of the elderly, low-income adults in the county include large numbers of uninsured residents who
did not qualify for ACA and suffer from chronic health and mental health problems.
Another topic of discussion was related to mental health and substance abuse care in the community.
The expert panel agreed that the David Lawrence Center is an asset to the community as a provider of
mental health and substance abuse services. However, experts reported it only has 66 in-patient beds.
Focus Group Reactions
78
The county’s sheriff’s office is the largest source of mental health referrals for mental health services
in the county. A majority of prison inmates have diagnosable mental health problems that are not being
treated, according to the group. Drug education is provided in the community and in schools through
the David Lawrence Center and Drug Free Collier County. Schools offer the “Hidden in Plain Sight”
program to educate parents about drug use, and Operation Medicine Cabinet helps people dispose
of medications kept at home. Group participants expressed concerns that opioid related mortality is
increasing in Collier County, as it’s the #1 treated condition in the detox center at David Lawrence.
When discussing community prevention and public health improvement programs, the expert panel
spoke about the implementation of the Blue Zone project in the county. The Blue Zone project involves
a national best practice approach to community prevention and health improvement. NCH is fully fund-
ing the program and working with a variety of community partners to implement it. Some of its current
focus areas include walkability and bikeability issues, reduction of hospitalizations and emergency
room visits, and nutrition. The project collects community level data via annual surveys in English and
Spanish. NCH is a leader in employee health promotion in the county with the goal of reducing health
care utilization in their own setting, and is helping the private sector do the same. It also promotes baby
friendly practices, such as breastfeeding rooms to promote lactation.
Expert participants also shared that the school system has a Safe Routes to School program to encour-
age children to walk or bike on a daily basis. Experts agree that the “Complete Street” program, men-
79
tioned previously, which aims to increase street access and safety for pedestrians and bikers, should
be extended to under-served areas of the county, such as Immokalee.
Finally, experts noted that many private physicians in the county work as volunteers in community clin-
ics, increasing access to specialists for low-income residents. These volunteers are able to offer cul-
turally-competent care in seven languages. Overall, Collier County’s small size and abundance of phil-
anthropically minded residents provides an opportunity for effective practices to produce quick results.
Issues related to health care were also brought up by community residents during the volunteer-led
focus groups. Many residents expressed that the healthcare system was not adequately prepared to
sustain the seasonal influx (population). Too few physicians (both generalists and specialists), clinics,
and Medicare accepting physicians were cited as problems across zip codes. Eighty percent of partici-
pants in these groups believed that mental health and substance abuse issues are major public health
problems. In addition, residents believe that there are root social environment issues, as well as access
and service issues, not allowing for solutions to the problems. There is a broad belief that the substance
abuse issues transcend age, race, and socio-economic status. Both prescription drugs and alcohol
seem to be substances of concern for most. Several groups also referenced the county jail as the big-
gest mental health facility, indicating the lack of specialized care and/or access to mental health care
within their community. One participant even praised the Sheriff’s office and county law enforcement,
remarking that the largest mental health facility is the jail.
24.1%
31.1%
10%
10.3%
24.4%
Figure 22a. Affordable Basic Health care: Elderly
Source: CC-CAS, Q-Q Research (2017).
18.6%
37.1%
12.8%
9.1%
22.5%
Figure 22b. Affordable Basic Health care: Children
Source: CC-CAS, Q-Q Research (2017).
80
Survey: Collier County Opinions
The CC-CAS survey also asked community members who live and work in Collier County a series of
questions focused on healthcare access, affordability, and services. Respondents were asked if they
believed that basic, affordable health care was available for children and the elderly in their communi-
ties. In general, residents agreed more often that this type of care was available for children more than
for the elderly. Overall, half of respondents (50%) agreed or strongly agreed that care was available
for children (Figure 22b), while only 41% agreed or strongly agreed that this care was available for the
elderly (Figure 22a). When asked if residents in their community had access to affordable medical care
without referring to a specific population, responses were somewhat similar to the above with 47% of
participants agreeing or strongly agreeing, and 35% disagreeing or strongly disagreeing. When asked
if residents had access to affordable health insurance, only 33% of residents agreed or strongly agreed,
while 46% disagreed or strongly disagreed. Participants were also asked if they believed that the unin-
sured had access to medical care in their community. Overall, 40% of respondents agreed or strongly
agreed, 32% disagreed or strongly disagreed, and over a quarter of the respondents (28%) didn’t know.
Residents feel access to affordable health insurance is an issue and that access to affordable medical
care without insurance is also problematic. Taken together, this can be interpreted to mean that access
to health care services for lower income groups is viewed as very difficult.
Don’t Know
Strongly Disagree
Strongly Agree
Agree
Disagree
Figure 23. Affordable Dental Care Availability
Source: CC-CAS, Q-Q Research (2017).
27.2%
27.2%
7.2%
18.1%
20.4%
81
Opinions regarding the availability of dental
care and mental health care aren’t as positive.
Respondents were asked if they believe that
residents in their communities had access to af-
fordable dental care. Only 34% of respondents
strongly agreed or agreed with the above state-
ment, while over 45% of respondents disagreed
or strongly disagreed with that statement (20%
didn’t know) (Figure 23). Taken together, while
many in the community feel that basic health
care is available, access seems to be deter-
mined by socio-economic status.
When asked if enough mental health services
are available to meet the needs of residents,
a little more than a quarter (27%) of respon-
dents agreed or strongly agreed, while 46% dis-
agreed or strongly disagreed (27% didn’t know) (Figure 24a). Similar percentages of residents agreed
to questions regarding the availability of addiction treatment options. A little less than a quarter (25%)
of respondents agreed or strongly agreed, while 45% disagreed or strongly disagreed (30% didn’t
know) (Figure 24b). When residents were asked if they were satisfied with the addiction services in
their community, only 26% responded that they were satisfied or very satisfied, while 32% stated that
they were dissatisfied or very dissatisfied (43% didn’t know). Generally, residents felt more positively
regarding the availability of prenatal services in their community, more than half (60%) of respondents
agreed or strongly agreed, while only 11% disagreed or strongly disagreed (28% didn’t know). Zip
code differences will be discussed in the community differences section below.
Figure 24a. Mental Health Care Availability
Source: CC-CAS, Q-Q Research (2017).
Figure 24b. Addiction Treatment Availability
Source: CC-CAS, Q-Q Research (2017).
25.2%22.7%
19.2%20.2%
5.4%6.4%
19.4%23.7%
30.8%
27%
82
Education
In 2016-17, Collier County Public Schools (CCPS) served a diverse population of 49,394 students in
grades K-12: 49% of students in grades K-12 were Hispanic, 34% were white and 11% were black.110
Approximately, 64% of students qualified for Free or Reduced-Price Lunch (FRL), which is often used
as an indicator of economic need. A significant percentage of students (9%) were classified as migrant
students (i.e., their parents are migratory or agricultural workers). Migrant students are considered to be
at risk education-wise, as constant relocation leads to educational discontinuity creating impediments
to progress and a possible dropout scenario.111 Approximately 16% of students were classified as En-
glish Language Learners (ELL), meaning that English was not their first language. These students are
provided with additional services designed to help them reach proficiency in English. More than 55% of
CCPS students in grades K-3 (the time during which children learn to read) are living in homes in which
English is not the first or primary language spoken.
One issue to take note of is the percentages of participants who were uninformed about health care
issues, responding that they “didn’t know” about health care services other than basic care. For many
questions, at least a quarter of the sample indicated that they didn’t know if specific health care ser-
vices (i.e. dental, mental health, addiction, prenatal) were available. This could be because the partici-
pants had not sought out that type of care, or it could indicate the public’s lack of awareness regarding
health care service issues.
CCPS employs approximately 3,200 certified teachers,
and almost half hold advanced degrees. The District
also receives assistance and service from over 5,500
volunteers each year.112 The State of Florida’s account-
ability system provides school grades of “A” through
“F” to each public and charter school. The grading for-
mula used focuses on the following school and district
performance outcomes: student achievement, learning
gains, graduation, acceleration success, and maintain-
ing a focus on students who need the most support.113
In 2017, CCPS was one of only 11 school districts to
receive an A grade by the Florida Department of Edu-
cation. CCPS was the 5th ranked district (out of 67) in
the state of Florida with respect to school grades, an
improvement from 14th in 2016 and 33rd in 2011.114 The
district showed growth in the number of schools earning
an “A” or “B” grade, up from 53% (2016) to 74% (2017),
with 46% of schools receiving an A in 2017. No school
in CCPS received an F grade from the state in 2017.115
83
There are many community organizations focused on
education, including early childhood and college and
career readiness. One such example is Future Ready
Collier (FRC), a network of more than 35+ organiza-
tions, businesses, schools and community members
working to improve the lives of children and families.
The FRC partners, which include RMSFF and CCPS
(along with many others), have two primary goals: 1) to
ensure that preschool-aged children in Collier County
are school-ready by the time they enter Kindergarten
(K) and 2) to ensure that young people achieve post-
secondary success by graduating high school on track
to obtain a degree or credential.116
With respect to early learning and Kindergarten readi-
ness, FRC notes that 34% of children in Collier County
are not Kindergarten (K) ready and about 4,000 eco-
nomically disadvantaged children are not enrolled in a
preschool program.117 As such, the network is focused
on increasing the percentage of low-income families
participating in programs/supports, increasing the
number of accredited/high-quality child care slots, and
increasing resources available to support early child-
hood development (among other initiatives).118
According to the most recent state data regarding
K-readiness (2013-14), 75-99% of students in the poor-
est areas of the county are classified as FRL, which
is well above the county average (currently 64%).
The K-readiness range for lower income zip codes
(34112, 34113, 34116 and 34142) is 40-90% with the
average falling around 63% in those zip codes.119 In
the county, only 18% of early childhood provider slots
are subsidized. It is estimated that there are approx-
imately 17,000 children ages 0-4 residing in Collier
County and about 5,000 (30%) of these children are
in poverty. Given that fewer than 1,000 low-income
children are currently accessing subsidized preschool
programs, there are at least 4,000 low-income young
children not enrolled in accredited early childhood pro-
84
grams each year.120 In order to measure the success of their efforts, the FRC intends to evaluate the
percentage of students considered at or above reading level upon entry to K as measured by the CCPS
iReady assessment. In 2016-17, only 24% of K-students enrolled in CCPS were considered to be at or
above reading level during the Fall i-Ready diagnostic. By mid-year, this percent improved dramatically
to 64%.121
With respect to their second goal of improving success post-high school, FRC is focused on reducing
the number of students that are off track in both middle and high school, improving the high school
graduation rate, and increasing the percentage of high school students completing the Free Application
for Federal Student Aid (FAFSA) among other initiatives. Research has indicated that a 10% increase
in FAFSA completion rate can lead to a 3% increase in students attending college.122
To reduce the number of students off track in middle school, CCPS has employed an Early Warning
System (EWS) and develops Students Success Plans (SSPs) for those identified as at-risk, in order to
help students stay on track to graduate and achieve postsecondary success.123 At the middle school
level, Florida Statute dictates that the EWS must use the following indicators: attendance below 90%,
one or more suspensions, course failure in English Language Arts (ELA) or Mathematics, or a Level
1 score on statewide assessments in ELA or Mathematics. If a student meets criteria for two or more
indicators, a school’s intervention team develops a SSP. As of March 2017, there were 1,257 students
in grades 6 through 8 who exhibited two or more indicators and consequently had an SSP. The students
identified as at-risk were more likely to be male (68%) and often struggled in reading. Interventions of-
ten included support for literacy and numeracy skills and mentorship for students.124
70% of Collier County Public
School Graduates enroll in College the
year after high school.
85
In order to assist students with the post-high school transition, at the high school level, CCPS offers
two types of dual enrollment opportunities to students 1) academic programs and 2) career education
programs.125 Academic dual enrollment allows students to simultaneously earn high school and college
credits. CCPS partners with Edison State college to offer programs in teacher education in Naples,
Immokalee, and Lely High Schools. In Lely High School, students can earn college credit in Aerospace
Technology/ Aviation though Embry Riddle University. Career Education Dual Enrollment allows stu-
dents to simultaneously earn a post-secondary adult education certificate along with their high school
diploma. This option is available through enrollment at Lorenzo Walker Technical High School and Lo-
renzo Walker Technical Center simultaneously or by enrolling in Immokalee High School and Immoka-
lee Technical Center simultaneously.126
Along with the dual enrollment opportunities, CCPS offers a variety of programming to assist students
with the post-high-school transition. During the 2016-17 school year, a college night hosted by CCPS
was attended by 95 colleges and universities and over 2,500 students and parents. In addition, finan-
cial aid and scholarship nights were organized at 8 high schools with 1,095 students and parents in
attendance. By March of 2017, approximately 37% of students had completed the FAFSA, compared to
31% the year prior. In 2017, CCPS graduated over 2,700 students with a graduation rate of 88.2%.127,
128 The most recently available data indicate that in 2015, 70% of CCPS graduates were enrolled in
college during the first year after high-school.129 The majority of these students attend 4-year in state
public colleges that are part of Florida’s State University System (SUS).
86
Other Social Services
Collier County is replete with agencies and organizations providing social services and programming
for residents. The United Way of Collier County sponsors the 211 hotline, a free 24-hour non-emer-
gency human services helpline available to residents by phone or online.130 The 211 service provides
referrals to a variety of health and social services that can connect residents with services addressing
a diversity of needs including food, housing, medical, and child care. According to the most recent pub-
licly available annual report for the 2014-15 fiscal year, 211 served 6,943 residents (1,967 by phone).
Counselors made 1,413 referrals for services.131
Residents are most likely to reach out to 211 in search of referrals for healthcare services, housing
services, income support, basic needs, and substance abuse issues.132 As stated by the annual report,
healthcare service referrals often include assistance with obtaining prescription drugs, medical treat-
ment, nursing services, hospital services, dental services, optometric services, and free healthcare
services. Housing service referrals frequently include helping clients locate affordable housing and
income assistance for rentals, obtaining an advance for a rental security deposit, or locating temporary
residences to assist with a transition. Income support referrals are provided to those with limited income
and can include assistance with utilities and other basic financial obligations for residents experiencing
an economic crisis. Basic needs referrals include assistance with the fundamentals needed for self-suf-
ficiency including food and clothing. Substance Abuse referrals are made to assist individuals with
addiction through their recovery process.133
Furthermore, Southwest Florida Resource Link is a service provided by the Health Planning Council
of Southwest Florida, Inc. (HPCSWF).134 The mission of the HPCSWF is to improve the health and
wellness of the Southwest Florida community by “promoting healthy lifestyles, reducing health dispar-
ities, increasing access to quality health related services, detecting and eliminating gaps in services,
expanding knowledge through education, and by facilitating community partnerships”.135 HPCSWF has
created a repository of human services available on the internet to provide a way for Collier residents
to find resources that meet their particular needs.
According to the HPCSWF Collier Resource Link website, there are approximately 330 programs and
organizations that provide a variety of social services to Collier residents.136 The website lists services
by category which include the following: adoption, child support, disabilities and health conditions,
financial assistance, healthcare, information resources, legal services, pet services, transportation,
advocacy, clothing, education and training, food, housing and utilities, insurance assistance, mental
health and substance abuse, and recreation. Resources listed include activities for youth, seniors, and
residents with disabilities, and include programming such as information sessions, counseling, parent
training, support groups, education and training, healthcare services, and food and housing assistance.
87
Focus Group Reactions
Issues related to education and social services were also discussed by community residents during the
volunteer-led focus groups analyzed by the Q-Q Research team. Many of the focus group participants
had little familiarity with the topics of education and childcare since the participants were often older
adults who did not live with children attending school.
The younger participants with experience involving education services echoed concerns related to
availability of preschool programming having an impact on school readiness. Residents stated that in-
sufficient Pre-K slots were a concern. Many believe that early education progams (VPK, PK) have long
waiting lists and/or are not entirely affordable. While VPK is provided for free for half the school day until
noon, the second half of the day requires payment and families can struggle to pay for the remaining
half. These concerns were amplified by the single mothers in the focus group.
On a positive note, many residents mentioned that the teaching staff within the public-school system,
grades K-12, are excellent. Parents in the focus groups indicated that, sometimes, they did have dif-
ficulties connecting with school staff during a child’s early learning phase and that seems to be the
most prevalent hurdle they face. With respect to post-high school options, residents believe the biggest
issue facing the community is an insufficient number
of, and lack of, funding for vocational schools. Again,
concerns were amplified by the single mothers in the
focus group. Lorenzo-Walker was cited as the only op-
tion for most residents. Differences and disparities dis-
cussed by residents in the Immokalee focus group are
provided in the Community Differences and Disparities
section below.
With regards to social services, the focus group par-
ticipants tended to believe that there are not sufficient
services for senior populations, for persons with dis-
abilities, and the general adult populations. Residents
remarked that CCPS does provide services for those
with special needs, but after one leaves that system,
the services for the special needs population tends to
diminish, leaving a service gap. Specifically, the spe-
cial needs focus group participants noted that there
was a dearth of quality group homes for them, and
that there are insufficient services and accommoda-
tions for adults with disabilities. It is worth noting that
many of the focus group participants admitted having
little-to-no contact or interaction with persons with spe-
cial needs. In general, there was a lack of awareness
among resident participants about these types of dis-
abilities and the needs of residents with special needs.
88
Survey: Collier County Opinions
The CC-CAS survey also asked community members in Collier County a series of questions focused
on childcare, education and enrichment, and social services. For the analyses involving questions
related to childcare, education, and services for youth, results below are reported only for those resi-
dents indicating that they were a parent of a child under 18 (n = 1,093). For questions regarding adult
education and social services, results are reported for all respondents who indicated they resided in
Collier County (n = 3,135). Any differences by zip code are discussed in the Community Differences
and Disparities section that follows.
Respondents were asked if they believed that basic, affordable child care was available in their com-
munities. Parents of children under 18 disagreed with this statement; only 35% agreed or strongly
agreed, while 51% disagreed or strongly disagreed (Figure 25a). A little more than half (51%) of par-
ents responded that they were satisfied with their childcare options. When asked if quality preschools
were available to Collier residents, the response was more positive; 67% of residents strongly agreed
or agreed with this statement (Figure 25b). In addition, a majority of parents (68%) reported being sat-
isfied or very satisfied with the preschool options. Taken together, the majority of residents believe the
preschool options available to be of high-quality, but often lacking in affordability.
33%
26%
9%14%
18%
Figure 25a. Affordable Child Care Availability
Source: CC-CAS, Q-Q Research (2017).
17%
46%
21%
9%
6%
Figure 25b. Quality Preschool Availability
Source: CC-CAS, Q-Q Research (2017).
Don’t Know
Strongly Disagree
Strongly Agree
Agree
Disagree
81% Do not think
there are affordable
childcare options .
89
In general, parents believe their K-12 educational system is high quality. Most parents (81%) agreed or
strongly agreed that children had access to high quality K-12 programs, with 77% of parents reporting
that they were satisfied or very satisfied with their K-12 options (Figure 26a). Additionally, most parents
agree or strongly agree that youth in the community are graduating high school workforce or college
ready (56%) (Figure 26b).
When asked if residents in their community had access to affordable after school care programs and
summer programs for their children, responses were similar, with 51% of participants agreeing or
strongly agreeing with both statements (Figures 27a and b).
10%
47.9%
33.6%
4.5%4%
Figure 26a. Quality K - 12 Education
Source: CC-CAS, Q-Q Research (2017).
17.6%
40.5%
19.3%17.9%
4.6%
Figure 26b. Graduating Work/College Ready
Source: CC-CAS, Q-Q Research (2017).
30%
33%
13%14%
10%
Figure 27a. Affordable After School Care Accessibility
Source: CC-CAS, Q-Q Research (2017).
24%
37%
14%13%
11%
Figure 27b. Affordable Summer Program Accessibility
Source: CC-CAS, Q-Q Research (2017).
90
Residents were also asked if they believed that adults 18 years and older had adequate access to post-
high school education in Collier County. For this question, results are reported for all respondents who
indicated they resided in Collier County (n = 3,099). About 54% residents agreed or strongly agreed
with this statement, while 24% disagreed or strongly disagreed (21% did not know). Along these lines,
57% of residents indicated that they were satisfied or very satisfied with both post-high school educa-
tional options and adult educational options (18% were dissatisfied or very dissatisfied, while a quarter
of the respondents answered that they didn’t know).
Upon analyzing respondent selections to ques-
tions regarding social services, the most com-
mon response was often the “don’t know” op-
tion (chosen approximately 40% of the time for
all questions). Given the nature of the survey
questions regarding social services, it is prob-
able that only those residents with first-hand
knowledge or experience with a particular ser-
vice would be likely to answer a particular ques-
tion. As such, for the questions in this section
regarding social services, percentages will be
reported based on the total number of partici-
pants who selected a valid response, excluding
the don’t know option.
When asked if residents in their community
who were in need had access to assistance
programs, participants were more likely to
agree or strongly agree (71%) (Figure 28a).
When asked if they were satisfied with social
service programs, only 44% of residents stated
that they were satisfied or very satisfied with
these programs (Figure 28b).
Social Services
20%
62%
9%19%
Figure 28a. Availability of Assistance Programs
Source: CC-CAS, Q-Q Research (2017).
33%
38%
6%
23%
Figure 28b. Satisfaction with Social Services
Source: CC-CAS, Q-Q Research (2017).
Strongly Disagree
Strongly Agree
Agree
Disagree
Very Dissatisfied
Very Satisfied
Satisfied
Dissatisfied
91
Respondents were also asked if they believed that adequate support services were available to resi-
dents with disabilities in Collier County. Responses were mixed; about 55% of the participants agreed
or strongly agreed, about 45% of the sample disagreed or strongly disagreed. About 60% percent of
the respondents reported being satisfied or very satisfied with disability services.
In addition, participants were asked if they felt that adequate support services were available to the
elderly in Collier County. For this question, responses are reported for the sample ages 61 and over (n
= 1,047). About 59% of residents ages 61 and over agreed or strongly agreed with this statement, while
33% disagreed or strongly disagreed.
Finally, residents were asked about their satisfaction with social services for special groups including
veterans, homeless, victims of domestic violence, and migrant workers. Residents were most likely to
respond that they were satisfied or very satisfied with services provided to domestic violence victims
and veterans, (63% and 54% respectively). Residents were less likely to indicate that they were sat-
isfied or very satisfied with services provided to migrant workers and the homeless, (43% and 36%
respectively).
92
Community Differences and Disparities
Health Care
Focus Group Reactions
According to the CC-CHA, White and Black residents are more likely to be insured than Hispanics. In
addition, the CC-CHA reported a correlation between insurance rates and educational attainment and
income level for residents of working age.137 As education and income increased, the likelihood of be-
ing uninsured decreased. The authors posit that this relationship is largely due to employment related
coverage, as residents at higher levels of education are more likely to be employed in jobs that provide
benefits packages. The CC-CHA reported a correlation between receiving dental care and both edu-
cational attainment and income level. As education and income increased, the likelihood of receiving
dental care also increased. Finally, the authors reported that residents were concerned about the lack
of pediatric dental care options.138
A special focus group was conducted with Immokalee
residents and led by the Q-Q Research team. Among
other topics, the topic of healthcare and education was-
discussed. When asked about issues related to health
care, according to group participants, most adults in
the Immokalee area are undocumented and don’t have
any type of health care. They rely mostly on emergency
room visits and the Collier County Health Clinic, which
provides non-emergency family health and dental care
on a sliding scale. Children from low-income homes are
covered under Healthy Kids. Residents noted that the
David Lawrence Center provides mental health services
that they can and do access, but they remarked that
services are only available 4 days a week (i.e., Monday
through Thursday, 8am to 6pm) at their satellite loca-
tion in Immokalee. This is problematic as many feel that
community residents have the tendency to suffer from
depression, stress, and anxiety, likely related to poten-
tial deportation and insecurity of relatives. Substance
Abuse services represent a huge unmet need in their
community. According to participating residents, alcohol
abuse is related to high stress, fear of deportation, and
depression. There are inadequate services to help alle-
viate substance abuse problems.
“Substance abuse
services represent
a huge unmet need...
there are inadequate
services to help sub-
stance abuse
problems.”
93
An additional special focus group was conducted with the Haitian residents and led by the Q-Q Re-
search team, to ascertain their needs and opinions with regard to health care among other topics.
When asked about issues related to health care, participants remarked that the majority of Haitians do
not have private health insurance or Medicaid coverage, and in general, the quality of medical services
for low-income residents in Collier County is lower than insured residents. Cultural barriers, such as
language and mistrust of non-Haitian doctors, are also an issue facing the Haitian community. Stigma
associated with mental health problems keeps Haitians from seeking help and mental health services.
Alcohol abuse does present an issue for their community, but it is largely ignored and unaddressed for
religious reasons. Drug abuse is more of an issue among young Haitians. Participants of the Haitian
focus group stated that more education is needed about health and prevention to combat the issues
listed above. Also, more community education is needed around the needs and services for children
with disabilities. Participants noted that stigma and cultural taboos keep parents from seeking help, and
language barriers can present challenges to assessing learning delays.
Disparity issues were also brought up by community
residents during the volunteer-led focus groups an-
alyzed by the Q-Q Research team. Almost entirely
across the board, focus groups voiced major con-
cerns over healthcare inequities, stating that income
determines both the access and quality of care one
receives. Dental care was identified as an especial-
ly costly medical service. The majority of the older
population were also concerned with senior medical
services. Many identified themselves as “snowbirds”
or “transplants” who, if encountered serious medical
conditions, would go “up north” for medical care. It
is also worth noting that the younger, female His-
panic/Latina residents who participated in the focus
group conducted in zip code 34116 shared their per-
sonal experience with, systematic racism within the
healthcare system. Treatment, access, and quality of
care were perceived by residents as poor due to lan-
guage barriers. “We have encountered many offices
that discriminate against us because of the language
barrier, which is very frustrating. We may not speak
English well, but we can understand how we are be-
ing spoken to and how we are being treated.” one
woman stated.
94
Survey: Collier County Opinions
Education and Social Services
Focus Group Reactions
According to results of the CC-CAS survey, residents residing in 34142 and 34143 (Immokalee) were
more likely to agree or strongly agree (66%) that affordable basic medical care for children was avail-
able in their community (as compared to 50% in the overall community). In addition, residents in this
area were more likely to agree or strongly agree (73%) that affordable basic prenatal was available in
their community (as compared to 60% in the overall community). Finally, residents in this community
were more likely to be dissatisfied or very dissatisfied with addiction services (51%), as compared to
the overall community (32%).
With respect to education and social services, focus group participants from the Immokalee area felt
that there are good quality early childhood and after school programs in their community (e.g., Guada-
lupe, CAN, Boys and Girls). Unfortunately, residents mentioned these programs all have waiting lists,
and there is not enough capacity to meet demand. All public schools offer after school programs, but
residents stated that children needed a recommendation to get in. Residents stated that many children
are cared for in family day care arrangements that may lack quality and are not licensed. Since agri-
cultural work requires non-traditional hours, many residents stated that traditional day-care services
with normal hours do not meet their needs; there are no alternate day care choices that work with their
schedules. Residents believed that the Middle schools in particular in their area suffer from high teach-
er turnover rates. As a result, classes are often taught by inadequately trained substitutes because
housing cost and shortages keep teachers from moving to Immokalee. Participants agree that there
are more adult role models in the community now encouraging children to succeed in school and go to
college. Residents discussed the Immokalee Foundation, which is providing scholarships for college.
In addition, iTech college offers 18-month vocational degrees. Residents did indicate a need for night
classes for adults in Immokalee. Residents noted that while there are these types of classes in Naples,
there is a lack of adequate public transportation (i.e., buses) to take potential students to these classes.
95
Survey: Collier County Opinions
During the Haitian focus group, it was noted that many Haitian working parents do not have the time for,
and/or do not know how to, advocate for their children in school around behavioral issues. They cited a
lack of understanding about educational requirements and testing in this country. As a result, they be-
lieve that their children may not be getting the services or attention they need, or, they may be subject
to lower educational expectations by their teachers. Residents stated that many young children in the
Haitian community do not go to quality child care or Pre-K programs, and as a result, they lack basic
skills when they start school. Residents indicated that these educational gaps that are present early on,
combined with promotion without qualifications, lead to Haitian youth dropping out of school. Partici-
pants believed that children in Title 1 schools get substandard education; they felt that teachers in these
schools are not well prepared and there is high turnover. More Haitian teachers and administrators are
needed, as well as more after school providers in order to act as role models and connect with the youth
of their community. Residents noted that many in the Haitian community turn to churches for program-
ming for children and youth. Participants stated that while adult education programs are available, the
ones that exist are of poor quality and classes are mostly offered in English. For residents who would
like to attend vocational schools for training, participants remarked that the community alternatives are
expensive and time consuming for working Haitians, thus making them out of reach for many.
An additional focus group was conducted with Seminole residents led by community volunteers. The
Seminole group educates their children on the reservation and their experience is fairly positive; they
like their teaching staff, and they believe they have sufficient vocational options in high school. They
do however feel that they are lacking extra-curricular activities that are available to kids and parents off
the reservation.
According to results of the CC-CAS survey, parents residing in 34142 and 34143 (Immokalee) were
more likely to agree or strongly agree that affordable child (58%) care and summer programs (63%) for
children were available in their community (as compared to 35% and 52% in the overall community).
Parents in Marco Island (zip code 34145) were also more likely to agree or strongly agree that afford-
able child care (58%) and summer programs (78%) were available. Parents in the following zip codes
were less likely to agree or strongly agree (25% or less agreed) that affordable child care for children
was available in their community: 34102, 34104, 34105, 34108, 34109, 34110, 34117, 34120. Parents
in the following zip codes were less likely to agree or strongly agree (40% or less agreed) that affordable
summer programs for children were available in their community: 34103, 34105, 34112, 34117, 34120.
In addition, residents in Copeland, Chokoloskee, Everglades City, Goodland and Immokalee (34137,
34138, 34139, 34140, 34142 and 34143 respectively) were less likely to agree or strongly agree (30%)
that services were available for the elderly in their community (as compared to 45% in the overall com-
munity).
96
Key Points
]With regards to health care services, residents are con-
cerned with PCP availability and wait times (especially
during peak season and for Medicare/Medicaid recipi-
ents). There is a lack of PCP providers in the Immokalee
area.
While there is a sufficient supply of dental care provid-
ers, residents are concerned with the affordability of
services which limits the use of dental care services.
Residents are worried about the lack of mental health
care and addiction treatment availability. Though the
number of providers has increased in recent years, gaps
in services remain.
A lack of affordable assisted living, residential options
for elderly, and for those with mental health issues and
disabilities continues to be a problem in the area.
97]Residents felt that income determines both the access
and quality of care one receives. Some residents are
concerned about discrimination experienced within the
healthcare system, and undocumented workers are
concerned about access to services.
Parents in many areas of the county cited a lack of af-
fordable child care and preschool options. In general,
parents noted that the available preschool and K-12 ed-
ucation programs are of high quality. Additional post-
secondary options were cited as an area of need.
Immokalee residents are concerned with the lack of
capacity in the quality preschool and afterschool pro-
grams. Many residents turn to unlicensed providers for
this care if spots in quality programs are unavailable.
Residents are concerned with high teacher turnover,
especially in middle school.
Residents in Copeland, Chokoloskee, Everglades City,
Goodland and Immokalee cited a lack of social services
for the elderly.
98
Introduction
Social Environment and Well Being
A community’s social environment has a pronounced and noticeable effect on its residents’ wellness.
Wellness can be defined in many different ways, and most experts believe the concept to be multi-
dimensional, including aspects of both physical health and mental health, along with other characteris-
tics.139 Overall, well-being takes into account how a person thinks about and feels about their own life.140
According to the World Health Organization, mental health can be defined as “a state of well-being in
which every individual realizes his or her own potential, can cope with the normal stresses of life, can
work productively and fruitfully, and is able to make a contribution to her or his community”.141 Features
of a community including safety and community cohesion affect individual health, while the formation of
social connections and satisfaction with one’s community are associated with well- being.142
Along these lines, community engagement can have an effect on the well-being of residents. One mea-
sure of resident engagement with a community is how often residents engage in volunteerism. When
individuals participate in volunteerism, they demonstrate commitment to their community, helping to
create better places to live for all residents. These experiences can create a sense of community cohe-
sion that ultimately helps to create a healthier population.143
99
Overall health of community residents can be influenced by how easily residents can access resources
needed to be healthy and happy. For example, improving access to recreation and leisure activities,
including parks and green spaces, leads to an increase in physical activity for residents, thereby reduc-
ing risks for both physical and mental health conditions (e.g, heart disease, diabetes, depression).144
Moreover, health and well-being are directly related to safety. Safe walkable and bikeable pathways can
lead to increased physical activity and reduction in chronic illness.145 High rates of crime and violence
in a community have an effect on well-being, as they foster an atmosphere full of stress and anxiety.
Increased arousal and chronic stress elicit negative physical responses (e.g. chronic pain, gastrointes-
tinal issues, and high blood pressure). In addition, fear for one’s safety creates barriers to engaging in
physical activity, such as walking in one’s neighborhood.146 A confluence of factors work to together to
create a positive social environment that allows residents to thrive and live happy, healthy, and full lives.
100
Data
Well-being and Community Cohesion
The Gallup-Healthways Well-Being Index® is a prominent measure of well-being that takes into ac-
count a multi-dimensional view of well-being that involves 5 key elements: purpose well-being, social
well-being, financial well-being, community well-being and physical well-being.147 Purpose well-being
is defined as “liking what you do each day and being motivated to achieve your goals”; social well-
being is defined as “having supportive relationships and love in your life”; financial well-being is defined
as “managing your economic life to reduce stress and increase security”; community well-being is de-
fined as “liking where you live, feeling safe and having pride in your community”; and finally physical
well-being is defined as “having good health and enough energy to get things done daily.”148 In the
Gallup-Healthways Well-Being analysis, data are gathered through telephone interviews of adults to
measure well-being in each of the aforementioned domains to create an overall well-being index which
can range from 0 to 100, with higher numbers representing increased well-being.149
According to their most recent analyses published in 2015, Florida is the 26th ranked state in the nation
with regard to well-being with an overall well-being score of 61.9. The overall well-being score for the
region of Southwest Florida is higher than that of the state at 68.6, while the score for the Naples area
is even higher than that of the region at 71.2. In the Naples area, the community well-being score was
highest of the five domains, and higher than scores at both the region and state levels.150 With respect
101
Health and Health Behaviors
to community well-being, in the Naples area, 76% of residents agreed that the city or area they lived in
was a perfect place for them, 81% of residents agreed that they were proud of their community (or the
area where you live) and 88% of residents indicated that they always feel safe and secure. In addition,
68% of residents interviewed evaluated their lives as “thriving”, while only 2% of those interviewed
evaluated their lives as “suffering”. Approximately 85% of residents indicated that they experienced
enjoyment or happiness.151
As mentioned in the previous section on Health Care, Southwest Florida is a participant in the Blue
Zones Project, “a community-wide well-being improvement initiative” designed to “help make healthy
choices easier” for Southwest Florida residents.152 As a result of these efforts, the well-being index in
Southwest Florida has been increasing despite a reverse trend throughout the nation.153
81% of residents are
proud of their community.
As stated in a previous section on Health Care, in 2016, the Collier County Community Health Assess-
ment (CC-CHA)was completed by the Florida Department of Health in Collier County. The authors con-
ducted a health status analysis and combined the results of this analysis with key information obtained
from surveys and focus groups involving residents to identify 5 strategic issues for improvement in the
county: chronic diseases, mental health, access to care, obesity and alcohol/drug abuse. Access to
care was discussed previously in the Service Environment section of the report. The remaining 4 stra-
tegic issues related to physical health and well-being will be discussed here.154
With respect to chronic disease and mortality, the leading causes of death in the county were identified
as follows: cancer, heart disease, Alzheimer’s disease, unintentional injuries, chronic lower respiratory
disease, cerebrovascular disease, diabetes mellitus, chronic liver disease and cirrhosis, Parkinson’s
disease and suicide, accounting for 77% of all deaths. Diabetes, ranked 7th, continued to pose sig-
nificant risk and is the cause of death most closely associated with obesity, another strategic issue
identified by the CC-CHA.155
102
The community has expressed the need for additional mental health services, and data presented in
the Service Environment section of this report indicate that the ratio of mental health providers to the
population is worse in Collier than it is in the state of Florida and the nation. That being said, Collier
County residents reported fewer issues related to poor mental health on average (7%) than the resi-
dents in the state (13%). With respect to differences among subgroups, females and residents ages
45 to 64 were more likely to experience mental health issues. In addition, mental health was positively
correlated with both income and education, with higher levels of both being related to improved mental
health.156
According to the CC-CHA, two most frequent harmful behaviors and unhealthy habits related are be-
ing overweight/obese and tobacco use. Taken together, the two factors account for approximately 35
percent of all preventable deaths in the county. Obesity levels account for 17% of all deaths annually.
While Collier County is healthier than the state of Florida with regards to overweight and obesity levels,
these conditions account for 17% of all deaths annually in the County, or about 1 out of every 6 deaths.
Education level can be considered to be a protective factor against obesity in the county as smaller
percentages of adults with advanced degrees are classified as obese (15%) as compared to residents
with a high school diploma (28%).157
Regarding alcohol and drug abuse, the CC-CHA stated that 18% of residents in Collier engaged in
heavy drinking in 2013, with males engaging in these behaviors at much higher rates than females.
Residents in Collier engage in these behaviors more frequently than residents in the state (17%) and
a larger proportion of residents age 65 and over engage in these types of behaviors than in the state.
Community residents recognize that this issue is exacerbated by the higher percentage of accidents
associated with drinking in the 65 and over population. Substance abuse issues, while improved among
adolescents, still plague the community with a negative impact. As previously stated in the Service En-
vironment section, the community recognizes that more affordable long-term substance abuse options
are needed.
103
Recreation & Leisure
With regard to recreation and leisure opportunities, Collier County boasts 1,775 acres of park land
along with 4,066 of conservation park land. Residents have access to 6 fishing piers, 68 sports fields,
11 recreational centers, 3 gyms, 5 fitness centers and 21 marinas/boat launch areas (among other
amenities).148 Collier County Parks & Recreation (CCPR) provided over 250,000 beach parking permits
and volunteers spent over 18,000 hours assisting CCPR with recreational projects. CCPR conducts
an annual SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis to guide their strategic
planning. Among several goals established in their strategic plan, CCPR plans to encourage Collier
County residents to actively participate in the planning, programming, and stewardship of Parks and
Recreation Resources, and to meet the unmet needs for recreation programs and services in the Coun-
ty through the development and implementation of best practices.159
In addition, Collier County is home to Artis-Naples, the principal center for the performing and visu-
al arts in Southwest Florida.160 Annually, Artis-Naples hosts “more than 800 concerts, performances,
exhibitions and educational events for children and adults from all backgrounds each year”. With a
commitment to the arts including enrichment and education, Artis-Naples is able to meet the needs of
community with the assistance of donors, patrons, and volunteers. With their help, Artis-Naples’ com-
mitment to “enrichment and education provides an inspirational resource for a diverse community”.161
104
Safety
According to the Collier County Sheriff’s Office Environmental Scan (CCSO-EA) published in 2017, as
of December 2016 there were 1,222 members of the Sheriff’s department (46% were law enforcement
officers, 21% were correctional officers, and the remaining 33% were civilian members). In addition,
the Sheriff’s Office reported 103 volunteer members contributing over 32,000 hours to the community
in 2016.162
With respect to crime rates in Collier County, official statistics show a 5.3% decrease in overall crime
from 2015-2016, though the rate of violent crimes increased 11.6 percent, largely due to an increase
in aggravated assaults. The majority of reportable crimes fell within the following categories: larceny
(61%), burglary (15%) and aggravated assault (14%). Moreover, the number of arrests in Collier Coun-
ty has declined since 2007. The CCSO-EA reports that while arrests leveled off between 2012-2015,
they dropped dramatically (by 12%) in 2016.163
Finally, the CCSO-EA reported that traffic accidents have been increasing over the past 5 years: acci-
dents have increased by about 50%. The principal concern related to the increase in accidents is the
accompanying increase in injuries and fatalities. Both crashes and fatalities have been increasing at
higher rates in Collier County and Southwest Florida than in the State of Florida.164
105
Focus Group Reactions
Issues related to community cohesion, recreation and leisure, and safety were discussed by community
residents during the volunteer-led focus groups analyzed by the Q-Q Research team. While residents
in focus groups discussed health care services, they did not engage in much conversation related to
health and health behaviors. Related to well-being and community cohesion, residents in the focus
groups noted feeling that their community lacked diversity and that they live in a “very homogeneous”
community with respect to age, ethnicity, and even religion and politics. Several people reported seeing
others using “trigger words” towards people of different ethnicities. Others have remarked on occasion
seeing community members being rude to people of other ethnicities who work in the community, and
one person went so far as to say that with respect to diversity and acceptance, there is “no civility, espe-
cially towards political discourse”. Several diversity gaps were also highlighted during the focus groups‘
conversations. Single mothers believed there was not nearly enough diversity within the community,
and that non-English speakers or those who were learning, were having a very difficult time integrating
into the community. In addition, teachers, police, and first responders noted that the community was
also having “troubled relations” with LGBT groups.
When discussing opportunities related to recreation and leisure, many focus group participants agreed
that while there were several opportunities for recreation and leisure, many of these opportunities
were costly, thus not accessible and affordable to all. Many residents stated that they would like to see
106
clean and safe public parks where free or inex-
pensive events could be hosted by the city and
local businesses. Residents reiterated the need
for better (i.e. safer, more abundant) bike paths,
easier beach access, and more benches at the
beach and park spaces.
With regard to safety, a majority of the focus
groups voiced concern over the safety of pedes-
trians and bike riders in the community. As stated
previously in the Physical Characteristics section
of the report, one area of particular concern in-
cludes the lack of proper commuter infrastruc-
ture (i.e. retrofitting/fixing roads) especially given
the recent growth in population. Many cited the
need for more lighting at night since populated
driving areas are quite dark after the sun goes
down. Bicycle riders do not feel safe given the
lack of bike paths, drivers do not feel safe about
bikers who have to go off the bike path, and pe-
destrians do not feel safe walking around due to
narrow sidewalks and/or lack of sidewalks. Many
residents also mentioned texting and driving to
be a major issue, voicing that public education
was needed.
52%
of residents agreed
they have access to
healthy foods.
Survey: Collier County Opinions
The CC-CAS survey also asked community members in Collier County a series of questions focused
on well-being and community cohesion, health and health behaviors, recreation/leisure, and safety.
Any differences by zip code are discussed in the Community Differences and Disparities section that
follows.
With regard to community cohesion and well-being, respondents were asked a series of questions
related to well-being and overall health. When asked if people in their community were accepting of
different backgrounds (including ethnicities, races and lifestyles), 70% of residents agreed or strongly
agreed, while 20% of residents disagreed or strongly disagreed. It should be noted that opinions of
focus group participants and opinions of survey participants differed with respect to this issue. Partic-
ipants were also asked if residents in their communities participated in faith based activities to create
community cohesion. Approximately 71% of residents agreed or strongly agreed, while 9% disagreed
or strongly disagreed (18% did not know).
Approximately 67% of respondents agreed that residents in their community are generally healthy.
When asked about alcohol use, illegal drug use, and prescription drug abuse, approximately half of
respondents indicated that residents struggled with all three types of substances in their communities
(Figure 29a, 29b, and 29c). With regard to overall health and well-being, residents were asked if fami-
lies in their community have access to affordable healthy food. Approximately 52% of residents agreed
or strongly agreed with this statement, while 35% disagreed or strongly disagreed (Figure 30).
107
45%
of residents agreed
that driving
under the influence
is a problem in their
community.
14%
38%
15%
6%
28%
Figure 29a. Residents Struggle with Alcohol Use
Source: CC-CAS, Q-Q Research (2017).
15%
35%
15%
7%
28%
Figure 29b. Residents Struggle with Illegal Drugs
Source: CC-CAS, Q-Q Research (2017).
15%
34%
12%
5%
33%
Figure 29c. Residents Struggle with Prescription Drug Abuse
Source: CC-CAS, Q-Q Research (2017).
Don’t Know
Strongly Disagree
Strongly Agree
Agree
Disagree
108
Community Differences and Disparities
Focus Group Reactions
8%
47%25%
10%
9%
Figure 30. Access to Affordable Healthy Food
Source: CC-CAS, Q-Q Research (2017).
With respect to recreation and leisure, over-
all residents agreed or strongly agreed that
they had adequate access to parks (84%),
adequate access to beaches (81%), and ade-
quate availability to arts/cultural programming
(76%). Only 52% of respondents agreed or
strongly agreed that arts and cultural activities
were affordable. Taken together, while resi-
dents are aware of the many opportunities for
recreation that exist in the community, many
residents likely struggle with the affordabili-
ty and access to these activities. In general,
residents responded that they were satisfied
or very satisfied with community recreational
centers (73%), shopping (80%), sports facili-
ties (72%), and arts facilities (69%).
Residents were also asked a series of questions related to the safety of their community. Overall, 73%
of participants indicated that they felt safe driving in their community, while 45% of respondents agreed
or strongly agreed that driving under the influence is a problem in their community. A smaller percent-
age of participants (63%) agreed or strongly agreed that they felt safe biking or walking around their
community. A majority of participants (75%) agreed or strongly agreed that they felt safe in their com-
munity at night. Over 80% of participants responded that they were satisfied or very satisfied with the
safety of their community, and 82% were satisfied or very satisfied with emergency services.
A special focus group was conducted with Immokalee residents led by the Q-Q Research team. Among
other topics, the topic of safety was discussed. Participating residents felt their community is safe, but
recognize that outsiders may not see it this way. Residents believed most working families are wel-
coming to newcomers; there is no gang or racial violence except for pockets in the southern sector of
Immokalee. Group participants felt the Sheriff’s department is doing a good job of community policing
and partnering with community organizations. Fear of deportation has has led to many residents being
fearful of interacting with the police, who have been deputized by ICE, although there has not been a
spike in actual deportations in the community.
An additional special focus group was conducted with Haitian residents led by the Q-Q Research team,
to ascertain their needs and opinion with regards to health and health behaviors, safety, and community
cohesion. Stigma associated with mental health difficulties keeps Haitians from seeking help. Partici-
pants stated that alcohol abuse is an issue in the Haitian community, but it is largely ignored and unad-
dressed for religious reasons. For this group, drug abuse is more of an issue among young Haitians.
More education is needed about health and prevention.
109
Survey: Collier County Opinions
According to results of the CC-CAS survey, only 36% of residents residing in 34142 and 34143 (Im-
mokalee) agreed or strongly agreed that residents in their community were generally healthy (as com-
pared to 67% in the overall community). Residents in Immokalee were more likely to agree or strongly
agree their residents struggled with alcohol use (66%) and illegal drug use (65%). They were also less
likely to agree or strongly agree (46%) that their residents had adequate access to affordable, healthy
food options.
In addition, the CC-CAS survey revealed that residents residing in 34142 and 34143 (Immokalee) were
significantly less likely to agree or strongly agree they had adequate access to parks (64%), adequate
access to beaches(35%), and adequate availability of arts/cultural programming (33%). They were also
less likely to agree or strongly agree that arts/cultural programming was affordable (33%).
Residents in Immokalee were also less likely to agree or strongly agree (62%) that they felt safe driving
in their community (as compared to 73% of overall participants), while 53% of respondents agreed or
strongly agreed that driving under the influence is a problem in their community. Residents were also
less likely to agree or strongly agree (51%) that they felt safe biking or walking around their commu-
nity and that they felt safe in their community at night (46%). Only 54% of participants in Immokalee
responded that they were satisfied or very satisfied with the safety of their community (as compared to
80% in the overall community), and only 60% were satisfied or very satisfied with emergency services
(as compared to 82% overall).
Most Haitians feel safe in their communities because they know their neighbors, but mistrust of outsid-
ers keeps them from reaching out to other cultural or racial groups. According to participants, younger
Haitians are more tolerant of diversity than their elders. There is agreement that the Haitian community
needs more spaces for cultural events. This group of residents also agreed that high traffic volume
during the peak season is a threat to pedestrians.
110
Key Points ]]In general, residents in Collier believe the residents
in the community to be healthy, and the region
exhibits a higher well-being score than the state.
In general, residents who do struggle with their
health have issues with chronic illness, substance
abuse, and obesity. These issues are of greater
concern in the Immokalee area.
With respect to safety, residents believe their
communities to be safe. Residents are concerned
with safety of pedestrians and bike riders, lack of
lighting at night for drivers, and texting and driving,
though 73% of residents felt safe driving. Again,
Immokalee residents are more concerned with
safety issues in their community than other resi-
dents in Collier County.
Regarding recreation and leisure opportunities,
community residents believe they have adequate
access to parks, adequate access to beaches, and
adequate availability of arts/cultural programming.
Residents expressed concerns related to the af-
fordability of recreational options. In general,
Immokalee residents are more likely to disagree
with statements regarding access to recreational
activities.
111
Community Identified Priorities
Survey: Collier County Opinions ]In order to identify the domain/issue that community members felt was most important to address,
survey participants were asked the following question: “Which of the following do you think should be
the top priority for Collier County’s leaders and elected officials to work on during the next two years?”
Respondents were able to select from the following options: 1) bringing better paying jobs to the area,
2) environmental preservation, 3) controlling housing costs, 4) managing growth and development, 5)
public education, 6) reducing traffic congestion, or 7) all of the above. Respondents also had the option
to select “other” and write in a priority not already listed.
A summary of resident responses is included in Table 5 below. Almost half of participants (45%) select-
ed controlling housing costs as a priority for the community, making this the top priority for respondents.
The second and third ranked priorities were bringing better paying jobs to the area and managing
growth and development; these were chosen as priorities by approximately 39% of residents. The next
most popular priorities were traffic congestion, selected by a quarter of participants, and environmental
preservation and public education, selected by about 22% of participants.
About 1/5th of the sample (20%) selected all of the above as an option, indicating that they felt all of
these issues should be a priority for community leaders. The most common responses by residents
who selected “other” were related to improving health care affordability and expanding mental health
and substance abuse services. The next most common open-ended responses involved transporta-
tion options, namely improving public transportation and increasing the number of safe pathways and
sidewalks for residents to bike and walk. Other open-ended responses indicated the need for more
affordable extra-curricular activities for both youth and seniors.
Responses
Priorities Estimate Percent of
Residents
Controlling housing costs 1521 45.30%
Bringing better paying jobs to the area 1321 39.30%
Managing growth and development 1300 38.70%
Reducing traffic congestion 847 25.20%
Environmental preservation 750 22.30%
Public education 742 22.10%
All of the above 700 20.80%
Table 6. CC-CAS Survey Responses: Community Identified Priorities
Source: CC-CAS, Q-Q Research (2017).
112
Finally, the following question was posed to residents who completed the CC-CAS, “In addition to the
elections for public office, there may also be a sales tax request on the ballot in Collier County. The
purpose would be to provide funding to acquire lands to protect water, wildlife, and public open spaces;
purchase safety vehicles and equipment; and construct and repair roads, bridges, traffic signals, parks,
drainage, waste water infrastructure, workforce housing, recreational and governmental facilities. What
is the likelihood you would support this ballot proposal?” About 23% of residents responded that they
would be unlikely or very unlikely to support this request, while 53% of residents responded that they
would be likely or very likely to support it. Almost a quarter of the sample (23%) responded that they’d
be somewhat likely to support a sales tax increase. Taken together, this result suggests the community
moderately supports a sales tax increase to address the above issues.
Very Unlikely
Don’t Know
Unlikely
Very Likely
Likely
Somewhat Likely
Figure 31. Support for Sales Tax Request
26%
27%
23%
11%
12%
113
Concluding Foundational Issue:
Economic Barriers for Residents
Foundational issues are considered to be needs that affect the lives of residents at many levels and
across multiple areas. These issues must be addressed to improve the lives of residents in Collier
County. Data leading to the identification of the County’s primary foundational issue has been present-
ed throughout the report in the Major Findings and Community Identified Priorities sections and in the
Appendices.
The primary foundational issue that consistently materialized across domains in this needs assessment
was related to the economic barriers many residents in Collier County are facing. An adequate income
usually bestows resources that foster a quality life for community residents — such as access to suit-
able housing, health care, quality schools, secure neighborhoods, and time and money to enjoy recre-
ational activities necessary for well-being. An adequate income also allows an individual the capability
to avoid threats to well-being — like air and water pollution and poor quality housing.
Throughout the needs assessment, experts and residents expressed concerns with economic issues
related to affordability of basic necessities like housing, health care, child care, and senior care. Cre-
ating opportunities for residents to earn a wage that is equal to (or even above) a living wage is key
to improving the happiness and quality of life of county residents. This will likely involve developing
employment opportunities with salaries that allow residents to meet needs, and enhancing training pro-
grams and educational opportunities that align with growth in higher paying occupations.
Collier County has the second highest income inequality in Florida, the top 1% in the area makes
73.2 times more than the bottom 99%.165 When income and wealth are highly concentrated, there is a
tendency towards developing policies that favor those who are prosperous.166 Throughout the needs
assessment, residents and community experts noted that income determined access to housing, health
care, child care, and senior care, and it was suggested that policymakers, corporations, and private
citizens frequently promoted opportunities that catered to wealthier residents (i.e., prioritization of de-
velopment of gated communities with expensive homes over affordable mixed-use developments, the
provision of concierge medical services over accepting Medicare/Medicaid, an expanding market for
child care options and assisted living for wealthy residents coupled with a lack of availability in afford-
able early childhood programs and assisted living options for seniors). The economic challenge that
many American communities, including Collier County, are faced with involves searching for strategies
that elevate the means of middle-class and lower income residents, providing them with a sufficient
share of the economy, thereby affording them the ability to meet their needs and purchase more of what
the local economy produces.167
114
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Q-Q Research Consultants
8060 NW 155th Street,
Suite 202
Miami Lakes, FL 33016
305.999.QQRC (7772)]]
1
2
Executive Summary
Overview
In the past two decades, Collier County has experienced tremendous growth and change in terms of
population dynamics and demographics, socio-economic transitions and in patterns of the health of the
community. Various characteristics of the population of Collier County correlate with select health status factors
and outcomes which drive the quality of life throughout the county.
Between 1995 and 2015, the resident population of Collier County grew at a swift pace of 2.8 percent per year
compared with Florida at 1.6 percent and the United States at 1.0 percent during the same period. This
tremendous rate of population increase generated unprecedented economic growth and development
throughout the county particularly between 1995 and 2007. Real median household income grew until 2007
after which the great recession was accompanied by rising unemployment and limited investment which placed
a significant burden on the social safety net of the county. Ethnic and socioeconomic transition has created a
shift in a number of public health indicators at the county level. The latest census bureau data available
indicate that in 2014, 53 percent of Collier County residents spoke a language other than English in the home.
This is directly correlated with the growth of the Hispanic population. The number of children living in poverty in
Collier County increased by 27.3 percent over the past decade.
The demographic dynamics of Collier County are being driven by the aging of the “Baby Boomer” cohort which
began to turn 65 years of age during 2011. As this older population increases to an estimated 145,000 by the
year 2040, other concurrent factors will affect the health and well-being of this cohort. Increased levels of life
expectancy will translate into an increment in the necessity for increased geriatric health care service
resources and availability. An increase in the demand for Assisted Living and Skilled Nursing beds is projected
in the immediate future due to both increases in longevity and the projected number of Alzheimer’s disease
cases.
Communicable and Infectious Diseases
Between the years 2005 and 2014, the incidence of all communicable diseases increased by 5.5 percent in the
county. Chlamydia is the leading communicable disease in Collier County accounting for 58.1 percent of all
reported infectious diseases in the county in 2014. Two of the five leading communicable diseases in Collier
County are enteric or gastrointestinal related. During 2014, salmonella and campylobacter accounted for 13.3
percent of all reported infectious diseases in the county.
Animal bites from potentially rabid animals have been increasing exponentially in Collier County during the past
ten years. Between 2005 and 2014, potential rabies exposures increased by over 97 percent. The prevention
of human rabies in Collier County has always been a public health priority due to the high risk wild life species
encountered naturally in the environment and the rapid land growth and development over the past two
decades.
Tuberculosis, once considered to have been virtually eliminated from the United States, continues to be
present in Collier County at a greater than average rate. In Florida and Collier County, medically underserved
low income populations tend to have a high rate of tuberculosis exposure and infection. These vulnerable
population groups disproportionately represent the majority of tuberculosis cases in the county. The risk of
mosquito–borne encephalitis, including West Nile virus, dengue and malaria, remain an ever present
underlying risk in Collier County due to the unique climate and weather conditions particularly during the rainy
season. Once confined in this hemisphere to the Caribbean and Central and South America, dengue has
emerged in recent years in the Keys of Monroe County, only a few hours away via highway and is an emerging
threat to Collier County.
3
Executive Summary
Health Behaviors and Outcomes
The two most prevalent unhealthy behaviors or lifestyle related habits in Collier County are tobacco use and
overweight and obesity. These two behaviors account for approximately 35 percent of all premature and
preventable deaths in the county. While Collier County is healthier than the state of Florida with regard to
overweight and obesity levels, these conditions account for 17 percent of all deaths annually in the county or
about 1 out of every 6 deaths.
In 2013, 20.8 percent of Collier County adults indicated they were obese; this was almost 6 percentage points
less than the proportion in Florida. Educational attainment is a protective factor against obesity in Collier
County, with only 15.3 percent of adults with a four year college degree or beyond classified as obese com-
pared with 27.6 percent with only a high school degree.
Cigarette smoking is the leading cause of preventable mortality in Collier County, followed by obesity.
Approximately 1 out of every 5 deaths in the county can be attributed to smoking. Cigarette smoking has been
scientifically associated as a cause in a myriad of diseases including numerous types of cancer, heart diseases
and stroke, respiratory diseases and unfavorable maternal outcomes. In Collier County, 13.9 percent of the
adult population identified themselves as current smokers.
A strong statistical association exists between alcohol consumption and alcohol impaired driving. Alcohol
related motor vehicle collisions and fatalities constitute a significant proportion of alcohol related deaths. On
average, in Collier County 54 residents are killed annually in motor vehicle crashes with approximately 25
percent attributed to alcohol use.
The proportion of Collier County adult residents who engaged in heavy or binge drinking was 18.1 percent in
2013. Males in the county engaged in heavy or binge drinking at a much greater rate than females, 22
percent and 14.5 percent, respectively. Overall, Collier County residents are more likely than Florida
residents to engage in heavy or binge drinking, 18.1 percent compared with 17.6 percent. Collier County
does have a greater proportion of the population 65 years and older engaged in heavy or binge drinking than
Florida, 9.8 percent compared to 7.2 percent, respectively. It is important to note that the community
recognizes the high percentage of drinking and auto accidents associated with the older population in the
county.
Although substance abuse rates have declined among adolescents in Collier County, it is a burden on public
health with severe consequences such as increased health care expenditures, accidents and crime. The
community has identified substance abuse as an issue that needs a comprehensive plan. While treatment
facilities for substance abuse exist, there is a shortage of affordable long-term rehab centers which can fully
treat the problem.
4
Executive Summary
Chronic Disease and Mortality
The leading cause of deaths in Collier County is cancer, which accounted for 25.5 percent of all mortality in
2014. Collier County has seen a substantial decline in this mortality rate since 2005. Diabetes is the 7th
leading cause of death in Collier County. The most significant risk factor for the development of diabetes is
obesity and overweight. Diabetes is also a significant cause of heart disease and stroke and the leading
cause of kidney failure. Obesity, as it relates to chronic diseases, has been identified by community health
care leaders and the general public as a key focus area for improvement within the county. Additionally,
although during the local public health system assessment, education and empowerment related to prevention
strategies was identified as a strength of the system, it was also noted that more substantial partnerships
need to be created in order to address issues such as chronic diseases and particularly to ad- dress obesity.
Community members emphasized the prevalence of unhealthy food options and limited healthy choices at
restaurants as well as the need to provide proper nutritional education.
In 2014, the 10 leading causes of death in Collier County by rank order were: cancer, heart disease,
Alzheimer ’s disease, unintentional injuries, chronic lower respiratory disease, cerebrovascular disease,
diabetes mellitus, chronic liver disease and cirrhosis, Parkinson’s disease and suicide. These 10 leading
causes accounted for 77 percent of all deaths occurring in the county. It should be emphasized the 10
leading causes of death do not all necessarily coincide with the causes of major public health importance.
Premature and preventable causes of death within a community tend to become public health priorities since
these causes or conditions affect the health status of the total population, and a reduction in morbidity and
mortality levels increases life expectancy and the quality of life at the county level.
Preventable Mortality
The actual causes of death are major external and modifiable influences and factors that contribute to specific
causes of death in our communities and its populations. These lifestyle and behavioral factors are correlated
and associated with a plurality, if not a majority, of all deaths. Almost one half of all deaths in Collier County are
potentially preventable, based on the premise that major actual cause of mortality can be modified though
education and access to care.
Tobacco use is the leading cause of preventable mortality followed by overweight and obesity resulting from
physical inactivity and poor dietary habits. Together, these two actual causes were responsible for 72 percent
of all preventable causes of death in Collier County in 2014. Health education initiatives and other public
health targeted programs are focused to assist in reducing the influence of these actual preventable causes
of death.
5
Executive Summary
Injuries
Injuries remain a leading cause of death for residents of all ages in Collier County. Males experienced
significantly higher mortality rates from injuries than females in any age group. From 2005 to 2014, the major
cause of injury deaths have varied by age in Collier County: motor vehicle fatalities between 15 to 34 years of
age and 85 years of age and older, falls among the older population 75 years of age and older, unintentional
poisonings between the ages of 25 to 54 years and drowning particularly in the 1 to 4 year childhood ages.
Maternal and Infant Health
Maternal and infant health is the foundation for a vibrant and prosperous society. The infant mortality rate for
Collier County declined to a new low of 4.6 infant deaths per 1,000 live births in 2014. The Hispanic infant
mortality rate in the county (4.0 per 1,000 live births) was 20 percent lower than the non-Hispanic rate
(5.0 per 1,000 live births). Pregnant women in Collier County continue to improve upon their health behaviors
by decreasing their reliance on alcohol and tobacco use. Collier County lags behind the state of Florida for all
three indicators related to adequate prenatal care: births with first trimester prenatal care, birth with late or no
prenatal care and births with adequate prenatal care. Community focus groups have pointed the need for a
good support system for receiving obstetrical care.
Health of the Older Population
During 2015, within Collier County over 12,000 residents 65 years of age and older had Alzheimer ’s disease; by
2030 using conservative population estimates, over 18,600 residents will be diagnosed with the disease. Not
surprisingly, community members identified the need for more nursing home beds within the county and
specifically indicated facilities that accept lower income residents were needed. The increased need for
expanding memory care facilities was identified as the population 65 years of age and over continues to grow
at historically high rates. The community perceived that the current market is catering to higher en d assisted
living facilities despite the increasing need for affordable long-term care and skilled nursing facilities.
Oral Health
Oral health is central to a person’s overall health, well-being and quality of life. Between 2002 and 2013, the
number of licensed dentists increased by 59.5 percent in Collier County. The majority of the dental care in the
county is provided by dentists in private practice. Persons without private insurance receive care at the Florida
Department of Health in Collier County, federally qualified health centers and the Naples Children and
Education Foundation Dental Center, along with limited services at the Senior Friendship Center and the
Neighborhood Clinic. The only dental care option for many low income people, particularly adults, who lack
access to preventative dental services is the hospital emergency room. Collier County residents with higher
income and higher education are more likely to visit a dentist or dental clinic than persons with lower income
and education. The availability of dental health services for children was identified by the community as a
concern.
6
Executive Summary
Access to Health Care
Private health insurance coverage is an integral mainstay for access to healthcare services for the core
working population 18-64 years of age and vital to the personal well-being and health of individuals. In
Collier County as throughout the country, rates of health insurance coverage have been declining over the
past two decades. This downward movement in health insurance coverage beginning in 2006 was
exacerbated by the recession, which pushed the uninsured population to historical heights as
unemployment spiraled upwards. With the recent changes involving the enactment of the new national
healthcare law, the uninsured rate in Collier County and in Florida appear to have been reversed. In 2014,
18.7 percent of the total resident population of Collier County was uninsured compared with 23.2 percent in
2010. Of the core working population 18 to 64 years of age in Collier County, 30.7 percent were without
health insurance compared with 35.9 percent in 2010, a difference of 5.2 percent. When accounting for
race and ethnicity, Hispanics in Collier County are more likely to be uninsured than non-Hispanic whites
and blacks. Health insurance coverage rates in Collier County and Florida are highly correlated with the
education attainment and income level. As the education level and income level increases, the percentage
of the uninsured population decreases–a classic inverse correlation. The association being that within the
core working population 18-64 years of age, on average, persons with higher education status are more
likely to be employed at an income level that provides for or facilitates health insurance coverage as
benefits to the employee. Focus group participants felt that there is a shortage of available health care
professionals, particularly those that service Medicare and Medicaid patients and the indigent.
Mental Health
Collier County residents experienced remarkably lower percentages of individuals who reported poor
mental health with a 7.3 percent in 2013 compared to Florida with a 12.7 percent, a difference of 5.4
percentage points. Females were much more likely to have experienced poor mental health than males.
Those in the age group 45 to 64 years of age had the highest incidence of poor mental health, while those
65 years and older had the lowest. Both income level and educational attainment correlate with mental
health status in Collier County. The higher the income and the more education both translated into
improved mental health status. Still, the community has been highly verbal about the need for more mental
health services, as currently a void exists for various levels of mental healthcare. Public awareness exists
on the issue and clearly feels the professional resources are lacking.
Conclusion
Health status analysis combined with the local public health system assessment results and information
from community focus groups and community surveys were used to identify key strategic focus areas for
Collier County. The strategic issues identified are: Chronic Diseases, Mental Health, Access to Care,
Alcohol and Drug Abuse and Obesity. The results of the Community Health Assessment, specific
assessment tools utilized and their results may be reviewed as follows.
7
Population Characteristics
Population characteristics are utilized in all aspects of public health measurements including
crude numbers, rates, ratios, proportions, life expectancy and incidence and prevalence levels.
These characteristics, which include population size, distribution, structure, growth and age
composition, are analyzed and monitored since they are associated with mortality and health
indicators. Demographic analyses are an essential epidemiological tool that aid in the
assessment of health status of a community.
Population trends allow health care professionals and analysts to strategically plan for levels of
utilizations of health services within communities and other geographical areas. These trends
also enable the assessment of current unmet and future health needs in specific subgroups and
vulnerable populations.
Analyses of population characteristics can result in statistically predictable health status
outcomes within a particular community. Following these data and analyses can help uncover
familiar and emerging trends at the local level. Since public health is population-based, the
coupling of demography with epidemiology results in a community health status assessment will
assist us to improve the health of Collier County.
8
Population Growth, Gender and Age Distribution
Between 1995 and 2015, the resident population of Collier County grew at a swift pace of 2.8
percent per year, which compares to Florida at 1.6 percent and the United States at 1.0 percent
during the same time period (Figure 1). In terms of actual numbers, Collier County’s population
increased by 147,533, from 199,272 in 1995 to a total of 346,805 by 2015.
Data source: U.S. Census Bureau
The annual average growth rate was the greatest between 1990 and 2000 with 5.2 percent.
From 2000 to 2015, the annual average growth rate significantly decreased, from 2.5 percent in
2000 to 2010 to 0.8 in 2010 to 2015 (Table 1).
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015Population
Year
Figure 1. Resident Population, Collier County, 1995 –2015
9
Table 1. Population Rate of Growth, Collier County, 1990, 2000 and 2010
1990 - 2000 2000 - 2010 2010 - 2015
Annual Rate of
Population Growth 5.2 2.5 0.8
Percentage Change 65.3% 27.9% 7.9%
Population 2000 Census - 251,377 2010 Census - 321,520 2015 Mid-Year - 346,805
Data source: U.S. Census Bureau. Annual Rates of Population Growth calculated by Epidemiology Program.
The resident population of Collier County is projected to increase by 144,023 from 2015 to
2040, resulting in a rate of growth of 1.4 percent per year for the period 2015 to 2040 (Figure 2).
After two decades (from 1990 to 2010) of accelerated population increases, Collier County’s
growth rate appears to follow the pace of the state of Florida through the year 2040.
Data source: Bureau of Economic and Business Research, Florida Population Studies, Bulletin 163
0
100,000
200,000
300,000
400,000
500,000
600,000
2010 2015 2020 2025 2030 2035 2040Population
Year
Figure 2. Total Population Projections, Collier County, 2010 –2040
10
By gender, the distribution of the population increased from a ratio of 101 females to every 100
males in 1995 and 2005 to 104 females to every 100 males by 2015.
As a biological and epidemiological rule, more males are born alive than females. The average
live birth ratio in the United States is approximately 106 males for every 100 females born alive.
In Collier County, as in all counties in the United States, mortality rates are higher for males
than for females at all ages. This variance in death rates results in life expectancy at birth being
on average 5 years greater for females than for males. This ultimately results in a greater
female population beginning around 45–54 years of age and increasing over males for every
age group thereafter.
Figures 3, 4 and 5 display the population pyramids for 1995, 2005 and 2015 for Collier County.
Data source: U.S. Census Bureau
1,179
4,468
5,831
5,292
4,523
4,202
11,858
12,856
11,245
12,028
15,772
8,418
2,354
1,284
4,698
5,902
5,446
5,299
5,293
13,374
13,349
10,260
10,309
14,883
7,739
1,410
30,000 20,000 10,000 0 10,000 20,000 30,000
<1
1-4
5-9
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
PopulationAgeFigure 3. Population by Age Distribution and Gender, Collier County, 1995
Female Male
11
Data source: U.S. Census Bureau
1,928
6,680
8,500
8,645
8,039
7,405
14,805
18,490
19,545
21,670
19,240
14,390
4,314
1,954
6,960
9,050
8,870
8,218
8,480
17,735
19,945
19,345
18,705
17,400
12,695
3,003
30,000 20,000 10,000 0 10,000 20,000 30,000
<1
1-4
5-9
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
PopulationAgeFigure 4. Population by Age Distribution and Gender, Collier County, 2005
Female Male
1,720
6,878
9,130
9,231
8,808
8,904
16,404
17,247
21,610
25,602
27,096
17,134
6,703
1,805
7,218
9,338
9,755
9,436
9,719
18,235
17,685
21,072
22,118
22,602
15,932
5,423
30,000 20,000 10,000 0 10,000 20,000 30,000
<1
1-4
5-9
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
PopulationAgeFigure 5. Population by Age Distribution and Gender, Collier County, 2015
Female Male
12
As can be visualized in these graphical presentations of the age and gender distribution, the
total population of Collier County increased by 74 percent between 1995 and 2015. These
dramatic shifts in the age distribution reflect the demographic transition that occurred in the
State of Florida and the United States.
This demographic change produced by the “baby boomer” cohort, which refers to those born
between the years 1946 and 1964, is a consequence of this generation entering and spanning
middle age to their retirement years. This highly visible demographic shift will have a significant
impact on healthcare access and socio-economic dynamics for Collier County and Florida
during the 21st century.
Between 1995 and 2015, the population 45 to 54 years of age in Collier County increased by 98
percent, while those aged 75 to 84 years experienced an increase of 104 percent. The most
dramatic increase occurred in those 85 years of age and older with a 222 percent increase.
Median age is defined as the age at which one half of the population is older and one half of the
population is younger. The median age in Collier County increased by 7.3 years between 1990
and 2014 (Figure 6). This is a direct consequence of the aging population in Collier as visually
described by the three population pyramids (Figure 3, 4 and 5).
Data source: U.S. Census Bureau
40.7
43.19
48
0
10
20
30
40
50
60
1990 2000 2014Year
Year
Figure 6. Median Age, Collier County, 1990, 2000 and 2014
13
Ethnicity
Between 1990 and 2014, the Hispanic population in Collier grew by 350 percent. While
Hispanics constituted less than 14 percent of the population in Collier in 1990, by 2014 the
proportion increased by more than 26 percent. This trend is expected to increase at an annual
rate of approximately 2.2 percent between 2010 and 2040, when the Hispanic population in
Collier County is projected to approximate a minimum of 160,000 (Figures 7, 8 and 9).
Data source: Bureau of Economic and Business Research, Florida Population Studies, Bulletin 172, June 2015.
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
2010 2015 2020 2025 2030 2035 2040Population Year
Figure 7. Population Projection by Ethnicity, Collier County, 2010–2040
Hispanic
Non-Hispanic
14
Data source: Bureau of Economic and Business Research, Florida Population Studies, Bulletin 172, June 2015.
Data source: US Census Bureau
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
2010 2015 2020 2025 2030 2035 2040Population Year
Figure 8. Hispanic Population Projection, Collier County, 2010 –2040
0%
20%
40%
60%
80%
100%
1990 2000 2014Percentage
Year
Figure 9. Percentage of Population by Ethnicity, Collier County,1990, 2000 and 2014
Hispanic or Latino
Non Hispanic or
Latino
15
Race
During the period 1994 and 2014, the black population increased by 152 percent from 9,525 to
24,033 (propelled mostly by Haitian immigration), while the white population decreased to
account for 90.0 percent of the population. Table 2 shows the population distribution over the 20
year period by race.
Table 2. Population by Race, Collier County, 1994, 2004 and 2014
1994 % 2004 % 2014 %
Black
9,525 5.0 18,191 6.1 24,033 7.1
White
179,286 94.1 271,285 91.6 305,925 90.0
Other
1,739 1.0 6,597 2.2 10,188 3.0
Data source: U.S. Census Bureau
16
Seasonal Population in Collier County
Collier County, like many Florida counties, draws a relatively large number of seasonal
residents and visitors during peak season as well as year-round. The largest proportion of
seasonal residents tend to be 65 years and older. The average age of visitors is just over 48
years of age; this is primarily due to the beaches of Collier County being a family tourist
attraction. In 2014, the number of tourists visiting Collier County was 1,773,900, an increase of
6.3 percent from 2013.
Peak Season Population
As evident in Figure 10, the peak season and the resident population in Collier County have
been growing and are projected to continue to increase at a constant and parallel rate between
2010 and 2030. On average, the peak season population is projected to be approximately 21
percent larger than the Collier County resident population. Between 2010 and 2030, the annual
rate of growth for the resident and peak season population is estimated to both be 1.7 percent
respectively.
Data source: Collier County Comprehensive Planning Section, 2015
0
100,000
200,000
300,000
400,000
500,000
600,000
2010 2015 2020 2025 2030Population
Year
Figure 10. Resident and Peak Season Population, Estimates and Projections,
Collier County, 2010–2030
Collier Resident
Population
Collier Peak
Season
Population
17
Socioeconomic Indicators
Income
Income and monetary resources are correlated with levels of health and well-being as a means
for individuals and families to obtain healthy foods, adequate housing and basic necessities
such as clothing and transportation. In the United States, these financial resources are also a
means for obtaining access to health care and health insurance. This statistical association
maintains validity with the multitudes of levels of family and individual income and is strongly
correlated with life expectancy.
Table 1 and Figure 1 provides the median household income for Collier County and Florida for
the period 2006 to 2014.
Table 1. Real Median Household Income (Adjusted in 2014 Dollars), Collier County and Florida, 2006 –2014
Year Collier County Florida
2006 $65,758 $53,283
2007 $66,171 $54,581
2008 $65,774 $52,360
2009 $58,468 $49,363
2010 $57,525 $48,035
2011 $53,135 $46,597
2012 $55,790 $46,199
2013 $55,067 $46,653
2014 $58,026 $47,463
18
Data source: U.S. Census Bureau/American Community Survey
Between 2006 and 2014, median household income in Collier County declined by 12 percent,
from $65,758 to $58,026. During the same period median household income in Florida
decreased by 11 percent, from $53,283 to $47,463. Between 2013 and 2014, median
household income increased in Collier County by 5 percent and by 2 percent in Florida.
Table 2 and Figure 2 shows the same median household income levels for Collier County and
Florida in comparison with the national United States data. This table and graph allow for a
relative comparison of the income levels of the three geographical entities during the period
2006 to 2014. During this time interval the median household income in the US declined by only
6 percent, about 50 percent less of a decline compared to that of Collier County and the state of
Florida. In Figure 2, it is evident that Collier County, due to its economic sensitivity to the
construction sector and the tourism industry, experienced the greatest decreasing volatility
compared with both Florida and the United States. The relatively small population of Collier
County (less than 350,000) coupled with its over-dependence on the housing market and
tourism contributed heavily to the effects from the Great Recession. This can be seen visually in
Table 2 beginning in 2008, when median household income for all three geographical areas
began to decline markedly. It has yet to recover to the level seen prior to 2006.
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
2006 2007 2008 2009 2010 2011 2012 2013 2014Income
Year
Real Median
Household Income,
(Adjusted in 2014
Dollars) Collier
County
Real Median
Household Income,
(Adjusted in 2014
Dollars) Florida
Figure 1. Real Median Household Income (Adjusted in 2014 Dollars),
Collier County and Florida, 2006–2014
19
Table 2. Median Household Income in Collier County, Florida and the United Sta tes,
2006–2014 (Adjusted in 2014 Dollars)
2006 2007 2008 2009 2010 2011 2012 2013 2014
Collier County $65,758 $66,171 $65,774 $58,468 $57,525 $53,135 $55,790 $55,067 $58,026
Florida $53,283 $54,581 $52,360 $49,363 $48,035 $46,597 $46,199 $46,653 $47,463
United States $56,860 $57,802 $57,076 $55,415 $53,836 $53,098 $52,586 $53,059 $53,657
Data source: U.S. Census Bureau/American Community Survey
The Women, Infants and Children Nutrition Program (WIC) of the US Department of Agriculture
provides food and nutritional assistance to pregnant and new mothers and children under five
years of age. Between 2005 and 2014, the number of WIC participants in Collier County slightly
$40,000
$45,000
$50,000
$55,000
$60,000
$65,000
$70,000
2006 2007 2008 2009 2010 2011 2012 2013 2014Income
Year
Collier County
Florida
United States
Figure 2. Median Household Income in Collier County, Florida and the United
States, 2006–2014 (Adjusted in 2014 Dollars)
20
declined from 7,967 to 7,688 (about 3.5 percent). However, caution should be exercised in
interpreting these data, as between 2005 and 2009 the number of participants increased by
over 35 percent, to 10,778–directly associated with the Great Recession (Figure 3). The number
of WIC enrollees in 2014 is still 111 percent higher than in 1990 and 50 percent higher than in
2000. While population growth in Collier County, which has significantly slowed during the last
decade, may have accounted for some of the increase in WIC enrollment beginning in the
1990s, a myriad of socioeconomic factors and variables when began in the past decade, have
generated stable higher enrollment levels in the county.
Data source: Collier County WIC Program
7,967
8,414
9,596
10,350 10,778
9,967
9,307
8,829
8,127 7,688
0
2,000
4,000
6,000
8,000
10,000
12,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Number
Year
Figure 3. Women, Infants and Children Program Participation,
Collier County, 2005–2014
21
As the real median household income in Collier County declined between 2006 and 2014 and
bottomed out at $53,135 in 2011, the number of WIC participants increased to a peak of 10,778
in 2009 (Figure 4). The correlation between family income levels and health related outcomes
and the necessity for public assistance has been well documented for the past century by
economists and public health experts. Since the Great Recession of 2007, these economic and
health statistical relationships have become more visible and evident as they emerge within
numerous socioeconomic indicators.
Data source: U.S. Census Bureau/American Community Survey and Collier County WIC Program
The number of children under 18 years of age living in poverty in Collier County increased by
over 72 percent during the period 2005 to 2014, while in Florida overall the increase was 33
percent.
Florida’s lower growth rate in poverty during this period can be attributed to a higher baseline of
persons being in poverty at the beginning of the analysis. The childhood poverty rate in Collier
County grew at a significantly greater rate between 2009 to 2014 than the state of Florida
0
2,000
4,000
6,000
8,000
10,000
12,000
$40,000
$45,000
$50,000
$55,000
$60,000
$65,000
$70,000
2006 2007 2008 2009 2010 2011 2012 2013 2014 WIC ParticipantsIncomeYear
Median Income WIC Participants
Figure 4. Number of Participants in the Women, Infants and Children Program and Median
Household Income (in 2014 Dollars), Collier County, 2005–2014
22
(Figure 5 and Table 3). In 2011, the childhood poverty rate in Collier County was 34.2 percent
with 21,154 children in poverty compared with 24.9 percent in Florida.
By 2014, Collier County’s childhood poverty rate was 27.3 percent compared to 23.8 percent in
Florida. At the present time, approximately 3 out of every 10 children in Collier County are
considered to be living in poverty. In Florida, it is about 2 out of every 10 children.
Data source: U.S. Census Bureau/American Community Survey
0%
5%
10%
15%
20%
25%
30%
35%
40%
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Percentage
Year
Figure 5. Percent of Children Under Age 18 Living in Poverty,
Collier County and Florida, 2005–2014
Collier County
Florida
23
Table 3. Number and Percentage of Children under the Age of 18 Living in Poverty,
Collier County and Florida, 2005–2014
Collier County Florida
Year Number Percent Number Percent
2005 10,284 16.6% 713,162 17.9%
2006 11,363 18.1% 689,315 17.5%
2007 11,157 17.3% 678,038 17.1%
2008 11,551 18.3% 721,284 18.3%
2009 11,520 18.0% 851,803 21.3%
2010 16,919 27.3% 923,963 23.5%
2011 21,154 34.2% 980,002 24.9%
2012 13,775 22.2% 1,000,736 25.4%
2013 13,437 21.4% 968,765 24.5%
2014 17,690 27.9% 948,465 23.8%
Data source: U.S. Census Bureau/American Community Survey
24
Homelessness in Collier County
Figures 6 and 7 show the number of homeless residents in Collier County for the period 2007 to
2011 as provided by admissions to St. Matthew’s House in Naples, Florida.
Data source: St. Matthew’s House
0
500
1000
1500
2000
2500
2007 2008 2009 2010 2011 2012 2013 2014Admissions
Year
Figure 6. Homeless Admissions, Collier County, 2007–2014
0
20
40
60
80
100
120
140
160
180
2007 2008 2009 2010 2011 2012 2013 2014Admissions
Year
Figure 7. Number of Homeless Children Admissions,
Collier County, 2007–2014
25
Between 2007 and 2009 admissions increased by over 92 percent, from 1,028 in 1979 to 1,979
in 2009. By 2014, the number had declined to 1,418, which is 40 percent greater than the
number in 2007. The number of homeless children admissions increased by 920 percent from
2007 to 2014. For the two most recent years with data available, the number of homeless
children remains at a historic peak high of 154 in 2013 and 153 in 2014.
26
Education
The relationship between health outcomes and educational attainment is well known in the
United States and globally. The reasons for this are multi-faceted, including that a higher level of
education usually results in a higher income. Educational level is also linked to access to
healthcare as health insurance is usually provided in jobs requiring a specific level of
educational attainment. Unemployment rates in the US are higher for individuals without a high
school diploma compared to those who are college graduates. Recent statistics show that the
college graduate unemployment rate averages to be 3 to 3½ times less that of those who did
not graduate high school. Those with lower educational attainment are more likely to be affected
by variations in unemployment and by consequence are more likely to be uninsured.
Statistically, those categorized as unemployed over time are more likely to experience lower
levels of health status and a higher incidence of chronic health conditions than the continuously
employed population.
Figure 8 shows the educational attainment in the population 25 years of age and over for Collier
County for 2005 and 2014. Between 2005 and 2014, the percent of the population in Collier
County only graduating from high school declined from 28.1 percent to 25.3 percent (a decrease
of 10 percent). During the same 10 year period, the percentage of the population with a
bachelor’s degree increased from 19.3 to 21.2 percent (an increase of 10 percent). The
percentage of the population obtaining a graduate or professional degree increased from 11.2
percent to 13.6 percent. This large percentage increment of approximately 21 percent is related
to the proliferation of graduate degree programs widely available online.
27
Data source: U.S. Census Bureau/American Community Survey
0%
5%
10%
15%
20%
25%
30%
No High School
Diploma
High school graduate Bachelor's degree Graduate or
professional degreePercentage
Educational Level
Figure 8. Educational Attainment in Population 25 years and Over,
Collier County, 2005 and 2014
2005
2014
28
Unemployment
Figure 9 shows the mid-year unemployment rates for Collier County and the State of Florida for
the period 2005-2014. In Collier County, the unemployment rate ranges from a low of 3 percent
in July 2006 to a high of 11.2 in 2009. During this same period the state rate ranged from a low
of 3.3 in 2006 to a high of 11.5 in July 2010. As can be seen in the graph, the unemployment
rates of the county run in tandem with those of the State of Florida over the ten year period.
Beginning in 2007, the rates for Collier and the state spiraled upward, hovering around 12
percent and 11 percent in 2010, respectively. As of July 2014, the rate for Collier County had
declined to 6.9 and Florida to 6.8. These unemployment rates have declined by 43 percent in
Collier and by 41 percent in Florida since the peak year 2010.
Data source: data from US Department of Labor, Bureau of Labor Statistics
A causal relationship between unemployment and health status has long been established in
public health research. Unemployment is associated with a decline in health status and a
decrease in the quality of life. Lack of employment is statistically detrimentally related to various
physical health outcomes including morbidity, mortality and suicide. Unemployment is correlated
0
2
4
6
8
10
12
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate
Year
Collier County
Mid Year Rate
Florida Mid
Year Rate
Figure 9. Unemployment Rates,
Collier County and Florida, 2005–2014
29
with numerous unhealthy behaviors including tobacco and alcohol consumption, poor diet and
lack of exercise. All of these behaviors are risk factors for the development of disease and
potential early mortality resulting in a reduction in average life expectancy.
The labor market’s distribution by sector also contributes to health outcomes. Employment in
sectors or professions requiring specialized or higher education brings higher income and work
related benefits, which ultimately leads to healthier lifestyles and increased longevity.
During the 10 year period, 2005 to 2014, the distribution of the labor force by industrial sectors
experienced several dramatic shifts in Collier County. The percentage of persons employed in
the construction industry declined by over 39 percent from 2005 to 2014. This was the sector
with the greatest job loses of the decade, due to the housing bubble of 2006 with the Great
Recession immediately following in pursuit in 2007, affecting new home construction since the
former date. Other work force sectors negatively impacted by the economic crisis of 2006–2007
in Collier County have been natural resources and mining, a decline of 31.5 percent, and
information technology, a decline of 22 percent. The largest increases in employment have
been in the educational and health services sector, with a 32 percent increase, and in leisure
and hospitality, with an 18.5 percent increase (Table 4).
Table 4. Distribution of the Collier County Labor Force, by sector, 2005 and 2014
Sector 2005 2014 Percent Change
Natural Resource and Mining 4.9% 3.4% -31.5%
Construction 15.3% 9.3% -39.6%
Manufacturing 2.5% 2.6% 2.6%
Trade, Transportation and
Utilities 18.2% 19.3% 6.1%
Information 1.4% 1.1% -21.7%
Financial Activities 5.8% 5.6% -3.9%
Professional and Business
Services 11.2% 10.5% -5.7%
Education and Health
Services 10.8% 14.4% 32.2%
Leisure and Hospitality 16.6% 19.7% 18.5%
Other Services 3.8% 4.5% 18.7%
Government 9.6% 9.7% 0.9%
Data source: Florida Department of Economic Opportunity, Labor Market Statistical Center, Quarterly Census of Employment and Wages Program.
30
Poverty and Food Assistance
The Supplemental Nutrition Assistance Program of the US Department of Agriculture provides
benefits that are used to purchase food at grocery stores, convenience stores and some
farmer’s markets and co-op food programs. Current requirements for eligibility includes a
household monthly net income of less than 100 percent of the federal poverty guideline.
Figure 10 shows the total number of individuals, adults and children receiving food assistance in
Collier County between 2005 and 2014. While the exponential population growth in Collier
County beginning in the 1990s had accounted for a constant increase in the number of
individuals receiving food assistance, between 2007 and 2012, the number of children receiving
food stamps increased by 351 percent while the number of adults increased by 335 percent.
Data source: Supplemental Nutrition Program and Department of Children and Families, Tallahassee, Florida
Figure 11 shows the correlation between median household income and children necessitating
nutritional assistance. The strong inverse statistical correlation between the 2 variables is clearly
visible. Between 2012 and 2014, the number of children receiving food stamps declined by 28
percent while the number of adult participants decreased by 19 percent. This decrease in
enrollment during this period of time is correlated with the decline of the unemployment rate.
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Participants
Year
Children
Adults
All Individuals
Figure 10. Number of Children and Adults Participating in the Supplemental Nutrition Assistance Program,
Collier County and Florida, 2005–2014
31
Data source: U.S. Census Bureau/American Community Survey and Supplemental Nutrition Program and Department of Children and Families,
Tallahassee, Florida
0
5,000
10,000
15,000
20,000
25,000
$40,000
$45,000
$50,000
$55,000
$60,000
$65,000
$70,000
2006 2007 2008 2009 2010 2011 2012 2013 2014 Children ParticipantsIncomeYear
Median Income Children Participants
Figure 11. Number of Children Participating in the Supplemental Nutrition Program and Median Household
Income (in 2014 Dollars), Collier County, 2006–2014
32
Chronic Disease
Chronic diseases are those illnesses of long duration and generally slow progression. These
diseases are the leading causes of death and disability in all states and counties in the United
States.
Approximately 70 percent of all deaths among Collier County residents every year are due to
chronic diseases, with heart disease, cancer and stroke accounting for over 50 percent of all of
these deaths annually. Approximately one out of every two adults in the United States has at
least one chronic disease or condition.
Most major chronic diseases are caused either directly or indirectly linked to four contributory
life style factors which are modifiable health risk behaviors:
1) Tobacco use
2) Lack of physical activity resulting in overweight or obesity.
3) Poor nutrition
4) Excessive alcohol consumption
These unhealthy behaviors are responsible for a majority of the diseases causing premature
mortality due to chronic diseases in Collier County and the United States. Approximately 50
percent of all adults in Collier County have at least one chronic condition or disease.
Overweight and obesity has become the major public health concern and actual cause of death
in Florida and the United States with at least one in every three adults being obese, and one out
of every five adolescents and teenagers categorized as obese.
33
Chronic Disease Mortality in Collier County
Chronic diseases are the leading causes of death and disabilities in the United States. Although
much improvement has been seen nationally, in Florida and in Collier County over the past two
decades, chronic diseases as a whole still account for over 70 percent of all deaths on an
annual basis. One reason for the prominence of chronic diseases in the world has been the
tremendous reduction in the incidence of the classical infectious and communicable diseases
during the last century due to the introduction of antibiotics and other infection control related
treatments and therapy.
When analyzing chronic disease mortality, specifically selected cancers by site, some rates may
fluctuate widely due to random variation. Figure 1 shows the cancer mortality rates for Collier
County and Florida for the period 2005 to 2014. During the decade 2005 to 2014, the death rate
from all cancers declined by 19 percent in Collier County and by 11 percent in Florida. By sex,
males in Collier had a decrease of 18.3 percent in the death rate compared to a decrease of
almost 21 percent for females (Figure 2). This decline in overall cancer mortality for males in
Collier County may be due in part to a decrease in the prostate cancer death rate. Females in
Collier County may be benefiting from decline in breast and cervical cancer mortality rates.
Cancer mortality by race is shown in Figure 3. Both the white and black population of Collier
County are experiencing steady declines in cancer mortality rates, with blacks showing a much
steeper decrease. This steep decline is due to the relatively small numbers of blacks residing in
Collier County coupled with the accompanying variation particularly in 2011 and 2014.
34
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 1. Cancer Mortality Rates,
Collier County and Florida, 2005–2014
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 2. Cancer Mortality Rates by Sex,
Collier County, 2005–2014
35
Cancer mortality by ethnicity is shown in Figure 4. Between 2005 and 2014 both Hispanics and
non-Hispanics experienced a decrease in death rates from cancer.
0
20
40
60
80
100
120
140
160
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 3. Cancer Mortality Rates by Race,
Collier County, 2005–2014
0
20
40
60
80
100
120
140
160
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 4. Cancer Mortality Rates by Ethnicity,
Collier County, 2005–2014
36
Between 2005 and 2014 the colorectal cancer mortality rate for Collier County remained fairly
constant with a slight downward slope over the 10 year period, while the decline for Florida was
similar but from a higher baseline level beginning in 2005 (Figure 5).
By sex, Collier County experienced similar declines from this cause of death, although the rate
for males declined faster and is presently approaching that for females as of 2014 (Figure 6).
0
2
4
6
8
10
12
14
16
18
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 5. Colorectal Cancer Mortality Rates,
Collier County and Florida, 2005–2014
37
Figure 7 shows the colorectal mortality rates by race in Collier County. Although the black
population of the county has been experiencing dramatic decreases in the mortality rate, the
number of deaths among blacks for this cause is too small on an annual basis to make a valid
statistical comparison.
0
2
4
6
8
10
12
14
16
18
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 6. Colorectal Cancer Mortality Rates by Sex,
Collier County, 2005–2014
0
5
10
15
20
25
30
35
40
45
50
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 7. Colorectal Cancer Mortality Rates by Race,
Collier County, 2005–2014
38
By ethnicity, the Hispanic population of Collier County is experiencing a surge in colorectal
cancer mortality rates while the rate for Non-Hispanics within the county has been trending
down between 2005 and 2014. Further investigation would be required to explain the
epidemiologic reasons for this dramatic increase by this cause (Figure 8).
Figure 9 shows the lung cancer mortality rates for Collier County and Florida for the years 2005
to 2014. Both the Collier County and the state of Florida rates are decreasing on a parallel
trend, although the rate for Collier County is declining slightly faster.
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier Non-
Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 8. Colorectal Cancer Mortality Rates by Ethnicity,
Collier County, 2005–2014
39
By sex, lung cancer mortality rates in Collier County are lower for females but declining more
rapidly among males (Figure 10).
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Florida
Collier County
Linear Trend
Florida Linear
Trend
Figure 9. Lung Cancer Mortality Rates,
Collier County and Florida, 2005–2014
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 10. Lung Cancer Mortality Rates by Sex,
Collier County, 2005–2014
40
By race, both white and blacks in Collier County have been experiencing an almost equal
declining slope in the lung cancer rate, as with other cancer site-specific mortality rates among
blacks, on an annual basis there is much variation due to the relatively small numbers of deaths
due to this cause in Collier County (Figure 11).
Figure 12 displays lung cancer mortality rates by ethnicity for Collier County for 2005 to 2014. It
is evident that the decline is at a steeper slope for Hispanics than that of non-Hispanics.
Between 2005 and 2014 Hispanic lung cancer mortality declined by 41 percent while mortality
among non-Hispanics declined by 34 percent during the same period of time.
0
10
20
30
40
50
60
70
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 11. Lung Cancer Mortality Rates, by Race,
Collier County, 2005–2014
41
Breast cancer mortality rates in Collier County have been declining dramatically over the ten
year period 2005 to 2014, from 19.6 to 13.5 per 100,000 population, respectively. The rate of
decrease in Collier County is more than 3 times that of Florida (Figure 13).
0
10
20
30
40
50
60
70
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 12. Lung Cancer Mortality Rates, by Ethnicity,
Collier County, 2005–2014
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 13. Breast Cancer Mortality Rates,
Collier County and Florida, 2005–2014
42
By race (Figure 14), whites in Collier County are experiencing the same rate of lower breast
cancer mortality as the total county, while the data for the black population is not comparable
due to effect of very small numbers as mentioned earlier for other specific cancer sites.
By ethnicity (Figure 15), Hispanics in Collier County experienced lower baseline levels of breast
cancer mortality than non-Hispanics. In every year between 2005 and 2014, Hispanics had
lower death rates (excluding 2006) due to breast cancer than non-Hispanics in Collier County.
While both ethnicities have been declining in their mortality rate trend, the rate for non-Hispanics
was 14.4 per 100,000 population in 2014, for Hispanics it was 9.2.
0
5
10
15
20
25
30
35
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 14. Breast Cancer Mortality Rates by Race,
Collier County, 2005–2014
43
While prostate cancer mortality rates in 2005 were very similar for both Collier County and the
state of Florida, by 2014 the rate for Collier County had decreased by 37 percent to 14.0 per
100,000 population and for Florida it decreased by 19 percent to 17.3 (Figure 16).
0
5
10
15
20
25
30
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 15. Breast Cancer Mortality Rates by Ethnicity,
Collier County, 2005–2014
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 16. Prostate Cancer Mortality Rates,
Collier County and Florida, 2005–2014
44
Prostate cancer mortality trends among the white population in Collier County is a mirror image
of that of the total male population as just described in Figure 16. The annual rates and the rate
of decrease between 2005 to 2014 are almost the same (Figure 17).
While the non-Hispanic prostate cancer mortality rates in Figure 18 emulate those rates of white
and total male population for Collier County, the rates for the Hispanic population are highly
variable with a declining slope mainly due to zero prostate cancer deaths in 2012 and 2014
among this population group.
0
10
20
30
40
50
60
70
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 17. Prostate Cancer Mortality Rates by Race,
Collier County, 2005–2014
45
Figure 19 shows the cervical cancer mortality rates in Collier County and Florida between 2005
and 2014. While the mortality rate from cervical cancer in Collier County has been declining
slowly depending upon the year, the death rate per 100,000 population for this cause
throughout the state has remained constant.
0
5
10
15
20
25
30
35
40
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 18. Prostate Cancer Mortality Rates by Ethnicity,
Collier County, 2005–2014
0
1
2
3
4
5
6
7
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 19. Cervical Cancer Mortality Rates,
Collier County and Florida, 2005–2014
46
By ethnicity, the cervical cancer mortality rate among Hispanics in Collier County has been
increasing steadily over the 10 year period, while the opposite is true for the non-Hispanic
population (Figure 20).
Figure 21 shows the melanoma mortality rates for Collier County and Florida, 2005 to 2014.
Over this ten year period the rate for Collier County is on a slightly increasing upward trend with
5 of the 10 years having higher rates than the 2.5 per 100,000 population in 2004. The
melanoma rate for Florida was flat over this period, 2.8 in 2005 and 2.8 in 2014, respectively.
0
2
4
6
8
10
12
14
16
18
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 20. Cervical Cancer Mortality Rates by Ethnicity,
Collier County, 2005–2014
47
Males in Collier County experienced significantly higher mortality rates from melanoma than
females (Figure 22).
0
1
2
3
4
5
6
7
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 21. Melanoma Mortality Rates,
Collier County and Florida, 2005–2014
0
1
2
3
4
5
6
7
8
9
10
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 22. Melanoma Mortality Rates by Sex,
Collier County, 2005–2014
48
Hispanics experienced significantly lower mortality rates from melanoma than non-Hispanics
(Figure 23).
0
1
2
3
4
5
6
7
8
9
10
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic
Linear Trend
Collier County
Non-Hispanic
Linear Trend
Figure 23. Melanoma Mortality Rates by Ethnicity,
Collier County, 2005–2014
49
Cerebrovascular disease, more commonly referred to as stroke, is the leading cause of death in
the United States and Collier County. In 2014, stroke accounted for 167 deaths in Collier County
or 5.5 percent of all deaths. Among males stroke was the fifth leading cause of death. Among
females it was also the fifth leading cause accounting for 23 percent more deaths than in males
in Collier County in 2014.
The risk of having a stroke is variable depending upon race and ethnicity. Black’s risk of having
a stroke is almost twice that of whites. Blacks also have a higher probability of dying following a
stroke than whites. Major risk factors for stroke include: high blood pressure, high LDL
cholesterol and smoking. Other health conditions and lifestyle behaviors which increase the risk
of stroke are diabetes, overweight and obesity, poor diet, lack of exercise and excessive alcohol
use.
Approximately two percent of both males and females 40 to 59 years of age have had a stroke
and on average six percent of men and seven percent of women 60 to 79 years of age have
had a stroke. Figure 24 shows the mortality rates from stroke for Collier County and the state of
Florida for 2005 to 2014.
0
5
10
15
20
25
30
35
40
45
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 24. Cerebrovascular Disease Mortality Rates,
Collier County and Florida, 2005–2014
50
Within the 10 year period both Collier County and Florida saw improvements in their stroke
mortality with a 16 percent decline for Collier County and a 12 percent decline for Florida. Figure
25 shows the mortality rates for Collier County by gender. As can be seen, both males and
females have been experiencing a gradual decline in mortality rates for the period 2005 through
2014, 16 percent and 15 percent, respectively.
The mortality rates for stroke by race are given in Figure 26. While whites are showing a steady
downward trend over the 10 year interval, blacks are experiencing an increasing trend in deaths
from stroke due to the much relatively higher mortality rates in 6 out of the 10 years. Historically
mortality due to stroke has been higher among the black population in the United States than
among the white population.
0
5
10
15
20
25
30
35
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 25. Cerebrovascular Disease Mortality Rates by Sex,
Collier County, 2005–2014
51
Figure 27 contains stroke mortality rates for Collier County by ethnicity for 2005 through 2014.
Both the Hispanic and the non-Hispanic population’s deaths from stroke are slowly declining at
an almost parallel slope, although the rates for Hispanics are at a slightly higher baseline level.
0
10
20
30
40
50
60
70
80
90
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 26. Cerebrovascular Disease Mortality Rates by Race,
Collier County, 2005–2014
0
5
10
15
20
25
30
35
40
45
50
2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 27. Cerebrovascular Disease Mortality Rates by Ethnicity,
Collier County, 2005–2014
52
Heart disease is the leading cause of death in the United States for both men and women.
Annually, over 600,000 Americans die from forms of heart disease, or approximately one out of
every four deaths per year. While more than 50 percent of all deaths caused by heart diseases
are presently in males, it is still the leading national cause of death in females as well. Although
mortality rates from heart disease vary by ethnicity, it remains the leading cause of death as well
among Hispanics, blacks and whites in the U.S. Approximately, 25 percent of all deaths in
blacks as well as whites are due to this cause, followed by Hispanics with about 21 percent of
all deaths.
Risk factors for heart disease include blood cholesterol levels, high blood pressure, diabetes
mellitus, tobacco use, diet, physical inactivity, obesity and excessive alcohol use. Genetic
factors most likely contribute in some role with regard to high blood pressure and specific forms
of diseases of the heart and vascular conditions.
The risks for diseases of the heart are highly correlated with unhealthy lifestyle choices and
habits such as cigarette smoking, failure to consume a healthy diet and obesity. In the United
States the prevalence of reported heart disease varies by age and sex. While the percentage of
adults ages 18 to 64 years with heart disease is similar for both males and females, for adults
65 years of age and over disease prevalence was significantly higher for males in 2014 in
Collier County. The age-adjusted rate for males for heart disease was 36 percent greater than
the mortality rate for females. There was a total of 436 heart disease deaths in males in Collier
County in 2014 compared with 369 deaths in females, a difference of 18 percent.
During the previous decade cancer replaced heart disease in Collier County and Florida as the
leading cause of death. This cause of death shift in ranking has been attributed to decades of
health education targeting heart disease prevention with particular emphasis on cigarette
smoking cessation, physical activity and exercise promotion and the strategic introduction of
healthy food choices education and the overall importance of healthy lifestyles. At the same
time that progress has been made with this reduction in the mortality rate for heart disease, the
major dominant competing cause of death, cancer, has become the number one cause of
mortality due to its high incidence and prevalence in the older population groups, in particular
those 45 years of age and over.
Figure 28 shows the mortality rates from heart disease for Collier County and Florida for the
2005 to 2014 time period. These data display a fairly consistent reduction in deaths over the ten
year period from this cause, 23 percent in Collier County and 18 percent in Florida.
53
Figure 29 describes the mortality rate from heart disease in Collier County for this period by sex.
Both males and females experienced an impressive improvement in heart disease deaths for
the ten year interval, -15 percent and -33 percent, respectively.
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 28. Heart Disease Mortality Rates,
Collier County and Florida, 2005–2014
0
20
40
60
80
100
120
140
160
180
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 29. Heart Disease Mortality Rates by Sex,
Collier County, 2005–2014
54
Heart disease mortality rates by race for Collier County are provided in Figure 30.
A disparity exists in the direction of the trend of heart disease mortality rates when comparing
whites with blacks. While the death rate decreased by 24 percent for whites over the 10 year
period, it increased significantly for the black population. In fact in 6 of the 10 years between
2005 and 2014, the heart disease mortality rate was higher for blacks than it was in 2005.
By ethnicity in Figure 31, both the Hispanic and non-Hispanic population of Collier County show
an improving trend, −20 percent and −23 percent, respectively.
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 30. Heart Disease Mortality Rates by Race,
Collier County, 2005–2014
55
0
20
40
60
80
100
120
140
160
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 31. Heart Disease Mortality Rates by Ethnicity,
Collier County, 2005–2014
56
Diabetes is the seventh leading cause of death in the United States and Collier County. It is
estimated that at the present time 27 percent of the population 65 years and older in the county
have the disease while a total of 22 million of the total U.S. population have the condition.
Based on extensive analysis the CDC estimates that over 79 million American adults 20 years
of age and older presently have pre-diabetes. The disease is a significant cause of heart
disease and stroke and the leading cause of kidney failure, lower-limbs amputations and new
cases of blindness among the adult population throughout the United States.
Both males and females are equally affected by the disease. Hispanics and blacks have a
higher prevalence of diabetes than non-Hispanics. The most significant risk factor for the
development of diabetes is obesity and overweight. Current prevalence levels of these lifestyle
behavioral conditions are reflected heavily with the correlations in the increase in diagnosed as
well as undiagnosed diabetes cases.
The obesity epidemic in Florida and the United States is directly related to levels of years of
potential life lost and the decrease in life expectancy with related population groups since the
risk of death among persons with diabetes is two times that of persons the same age without
diabetes. In examining Figure 32, it is very evident that for both Collier County and Florida while
the trend has been very slowly declining over the decade, diabetes remains a very important
contributing cause of death to premature mortality for both geographical areas.
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear
TrendFlorida
Linear
Trend
Figure 32. Diabetes Mellitus Mortality Rates,
Collier County and Florida, 2005–2014
57
0
2
4
6
8
10
12
14
16
18
20
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 33. Diabetes Mellitus Mortality Rates by Sex,
Collier County, 2005–2014
0
10
20
30
40
50
60
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 34. Diabetes Mellitus Mortality Rates by Race,
Collier County, 2005–2014
Figure 33 shows the diabetes mortality rate by sex over the 10 year period, 2005 to 2014. Both
males and females have been trending slowly downward long term. On average, the mortality
rates for males from diabetes in Collier County is approximately twice that of females.
The black population in Collier County has been experiencing a steadily increasing mortality
trend over the 10 year period while the white population’s rate has been essentially flat with no
discernible change (Figure 34).
58
Figure 35 shows the diabetes mortality rates by ethnicity. There is a visible contrast between the
downward sloping trend among Hispanics and the flat line trend among non-Hispanics in Collier
County.
0
5
10
15
20
25
30
35
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 35. Diabetes Mellitus Mortality Rates by Ethnicity,
Collier County, 2005–2014
59
Chronic lower respiratory disease (CLRD) comprises three major diseases: chronic bronchitis,
emphysema and asthma. It is medically accepted that cigarette smoking is a causal factor in the
development and progression of emphysema and chronic bronchitis.
Mortality rates for CLRD have been declining in the United States for males since the late
1990s, while the death rate from this cause of death has not changed significantly over the past
two decades.
In 2014, CLRD was the fifth leading cause of death in Collier County and the third leading cause
in the state of Florida. By sex, in Collier County, it was the fourth leading cause of death for
males and for females. Figure 36 shows the mortality rates from CLRD in Collier County and the
state of Florida for 2005 through 2014.
0
5
10
15
20
25
30
35
40
45
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear
Trend
Florida
Linear
Trend
Figure 36. Chronic Lower Respiratory Disease Mortality Rates,
Collier County and Florida, 2005–2014
60
0
5
10
15
20
25
30
35
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 37. Chronic Lower Respiratory Disease Mortality Rates by Sex,
Collier County, 2005–2014
0
5
10
15
20
25
30
35
40
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 38. Chronic Lower Respiratory Disease Mortality Rates by Race,
Collier County, 2005–2014
Both males and females in Collier County show increasing trends in mortality rates from CLRD
over the 2005 to 2014 period (Figure 37).
Figure 38 shows the death rates for CLRD by race. Over the ten year period, the white
population have been on an increasing trend while deaths among blacks have been declining. It
should be noted that this decline in mortality may be due to small number variation and the fact
that the mortality rate for blacks in 2005 was at a substantial higher level than the rate that year
among whites.
61
It is clear in Figure 39 that with the exception of the years 2005, 2006 and 2012, that non-
Hispanics experienced significantly higher death rates from CLRD than Hispanics. The 10 year
rate trends by ethnicity have been moving in opposite directions.
0
5
10
15
20
25
30
35
40
45
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 39. Chronic Lower Respiratory Disease Mortality Rates by Ethnicity,
Collier County, 2005–2014
62
Infectious Diseases
Infectious or communicable disease are illnesses that are caused by pathogenic organisms
such as viruses, bacteria, parasites and fungi. Some infectious diseases present as mild
illnesses, but others can be fatal. Infectious disease can be acquired by consuming
contaminated food or water, by being bitten by insects or animals and by having contact with an
infected person. Many communicable disease are preventable; prevention generally depends
on the particular illness and its modes of transmission.
The Florida statutes require that a number of communicable diseases be reported by
physicians, hospitals, urgent care centers and labs to the local health departments. Within the
Florida Department of Health in Collier County and the Communicable Disease Control and
Prevention Division, there are four programs that are responsible for reporting these diseases:
Tuberculosis Program, HIV Program, STD Program and the Epidemiology Program. The
Epidemiology Program investigates and reports all infectious diseases apart from Tuberculosis,
STDs and HIV. It is a priority of the Florida Department of Health in Collier County to prevent
infectious diseases and other threatening public health conditions in the community.
63
Total Reportable Disease Cases
In 2014, a total of 1,388 disease cases (or about 408 per 100,000 population) were reported in
Collier County, excluding chronic hepatitis B and C (cases of chronic hepatitis B and C are
reported but not investigated and, therefore, are not included in the overall disease case count).
Between 2005 and 2014, reportable disease incidence in Collier County increased by 5.5
percent (Figure 1). A similar pattern was seen for the State of Florida. The reasonable public
health explanation for this uptick in Collier is the economic recession and its related impact on
the community. Collier County continues to have among the highest reportable disease case
rate throughout Southwest Florida.
Data source: Florida Department of Health
In Collier County, five diseases and conditions account for 80 percent of all investigations
carried out by the different programs in the Florida Department of Health in Collier County
(Table 1).
0
300
600
900
1200
1500
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Number of CasesYear
Figure 1. Number of Total Reportable Disease Cases per 100,000 Population,
Collier County, 2005–2014
64
Table 1. Five Leading Communicable Diseases and Health Conditions Reported, Collier County, 2014
Rank Order Disease or Condition Number of Cases Percentage of ALL
Reportables
1 Chlamydia 807 58.1
2 Salmonella 120 8.6
3 Campylobacter 65 4.7
4 Gonorrhea 62 4.5
5
Animal Bites (Post
Exposure Prophylaxis
Recommended)
52 3.7
Total 1,106 80.0
Data source: Florida Department of Health in Collier County, Epidemiology and Health Assessment Program
The Epidemiology and Health Assessment Program investigates investigated a total of 412
reportable diseases and conditions, about 30 percent of all reportable diseases and conditions.
Between 2005 and 2014, the incidence rate of these reportable communicable diseases in
Collier County increased by 2.6 percent. If population growth is not taken into account, the
number of diseases increased by 14.1 percent over this same interval.
65
Enteric Diseases
Historically, enteric disease incidence in Collier County has been consistently greater than the
Florida State average. Between 2005 and 2014, the enteric diseases for Collier and Florida
followed a similar pattern (Figure 2). During this ten year period, the enteric disease rate
decreased by 13 percent, while in Florida the rate increased by 14.3 percent. Collier County is
considered to have fairly complete disease reporting levels when compared to the state as a
whole. This is reflected in the higher reported disease incidence in all years.
Data source: Florida Department of Health
Two of the five leading reportable diseases in Collier County are enteric or gastrointestinal
disease. Salmonellosis and campylobacteriosis accounted for 185 or about 17 percent of all
reportable conditions (Table 1). All reportable enteric diseases; which also includes
cryptosporidiosis, cyclosporiasis, shiga toxin-producing Escherichia coli, giardiasis, hepatitis A,
shigellosis, and typhoid fever; account for 22 percent of all reported diseases and conditions in
Collier County and were about 60 percent of all cases investigated by the Epidemiology and
Health Assessment Program in 2014.
0
10
20
30
40
50
60
70
80
90
100
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100, 000Year
Figure 2. Number of Enteric Disease Cases per 100,000 Population,
Collier County and Florida, 2005–2014
Collier County
Florida
66
It should be noted that the reason for the variability or wide fluctuations in Collier County’s rate
in any of these disease specific graphs is due to the concept of random variation. Collier County
with a relatively small resident population of 340,146 in 2014 is only 1.7 percent that of Florida’s
19,548,031. Due to this difference in population size, Florida’s denominator will be much more
stable than Collier County’s and is not subject to variable fluctuation due to relative changes in
the numerator.
Salmonella
Salmonella is a bacterial infection usually causing diarrhea, fever and abdominal cramps. In
some cases, the diarrhea may be so severe that the patient needs to be hospitalized.
Salmonella infections are the second most reported condition in Collier County. The incidence in
Florida and in Collier County has had increasing trends over the last 15 years. Although the rate
slightly decreased by 8 percent in Collier County between 2005 and 2014, there is an upward
trend in salmonella infections for this time period (Figure 3).
Data source: Florida Department of Health
0
5
10
15
20
25
30
35
40
45
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Figure 3. Number of Salmonella Cases per 100,000 Population,
Collier County and Florida, 2005–2014
Collier County
Florida
67
Campylobacter
Campylobacter is one of the most common bacterial causes of diarrheal illness in the United
States. It is estimated that over 1.3 million persons in the U.S. every year are affected by this
disease; therefore, a majority of cases go undiagnosed and unreported. Symptoms of
campylobacter include diarrhea, cramping, abdominal pain and fever.
Between 2005 and 2014, the rates for Collier County decreased by 25 percent, while the rate of
Florida increased by about 130 percent (Figure 4). Although, historically, the overall
campylobacter incidence in Collier has been on average 3 to 4 times higher than that for
Florida, the difference has been decreasing in the past few years.
Data source: Florida Department of Health
0
5
10
15
20
25
30
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100, 000Year
Figure 4. Number of Campylobacteriosis Cases per 100,000 Population,
Collier County and Florida, 2005–2014
Collier County
Florida
68
Giardia
Giardiasis is a diarrheal disease caused by a microscopic parasite. This parasite is found in soil,
food or water that has been contaminated with feces of infected humans or animals. Although
giardiasis occurs worldwide, prevalence appears to be higher in the Caribbean and other Latin
American countries than in Florida and the United States. In the United States, it is more
commonly found in lakes, rivers, springs, ponds and streams.
Between 2005 and 2014, the rate for giardiasis in Collier County declined by 71 percent (from
13.1 to 3.8). The rate peaked in 2009 with 19.1 per 100,000 population and decreased by 80
percent from 2009 to 2014 (Figure 6). One of the major correlates of the decline of giardiasis
incidence in Collier County from 2011 to 2014 has been the case definition changes in 2011.
Prior to 2011, all cases that met the laboratory criteria regardless of clinical presentation were
reported. In 2011, a clinical criteria was included in the case definition, thus increasing the
specificity of the reporting system and reducing the rate of this disease.
Data source: Florida Department of Health
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Figure 6. Number of Giardiasis Cases per 100,000 Population,
Collier County and Florida, 2005–2014
Collier
County
Florida
69
Shigellosis
Shigellosis is an acute bacterial disease involving the small intestine and colon. Most cases are
acquired as a result of the bacterium passing from the stool or soiled hands from one person to
the mouth of another. As with most infective diseases frequent hand washing with soap
significantly reduces the risk of acquiring the disease. Shigellosis is more prevalent and may be
recurrent in environment where low hygiene standards exist. It is more common in warm
weather. The majority of cases in the United States occur in children 2 to 4 years of age
particularly in child care settings; therefore, the most common associated shigellosis risk factor
in Collier County is being a toddler or an employee in a child care facility.
Between 2005 and 2014, the rate of reported cases of shigellosis declined by 34.7 percent, from
4.9 to 3.2 per 100,000 population. However, there is an increasing trend of shigellosis in the
county. Collier’s rates peaked in 2012 with a rate of 7 per 100,000 population. The rate for
Florida increased by 108.5 percent over the same period (Figure 7).
Data source: Florida Department of Health
0
2
4
6
8
10
12
14
16
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100, 000Year
Figure 7. Number of Shigellosis Cases per 100,000 Population,
Collier County and Florida, 2005–2014
Collier County
Florida
70
Hepatitis A
Hepatitis A is a contagious disease of the liver caused by infection with the hepatitis A virus.
Transmission can occur from ingesting food or drinks contaminated by the feces of an infected
person and from having close contact with an infected person. Hepatitis A is more prevalent in
countries and areas where poor sanitary conditions and low levels of personal hygiene exist.
While incidence of hepatitis A is low in the United States and other developed countries, the
endemicity in Central and South America can be very high with case rate reaching 150 per
100,000 population annually.
Between 2005 and 2014, the rate of reported cases of hepatitis A decreased significantly to 0.6
and 0.5 per 100,000 population for Collier County and Florida, respectively. The hepatitis A rate
decreased by 86 percent in the county. In Florida, the decrease amounted to 66.7 percent
(Figure 8). While annual fluctuations in reported cases have occurred, these low rates are
directly attributed to the introduction of the hepatitis A vaccine in 1995.
Data source: Florida Department of Health
0
1
2
3
4
5
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100, 000Year
Figure 8. Number of Hepatitis A Cases per 100,000 Population,
Collier County and Florida, 2005–2014
Collier County
Florida
71
Vaccine-Preventable Diseases
Vaccine-preventable diseases, as the name implies, are infections that can be prevented;
however, every year several vaccine-preventable disease are reported in Collier County. In fact,
they account for approximately 10 percent of all cases investigated by the Epidemiology and
Health Assessment Program at the Florida Department of Health in Collier County. These
diseases include diphtheria, measles, meningococcal disease, mumps, pertussis, poliomyelitis,
rubella, tetanus and varicella. The two most reported vaccine-preventable diseases in the
county are pertussis and varicella.
Pertussis
Pertussis or whooping cough is an acute bacterial infectious disease caused by Bordetella
pertussis. During the 20th century, pertussis was one of the most common childhood diseases
and a major contributor to childhood mortality in the United States. Beginning with the
widespread use of vaccine, pertussis incidence declined more than 80 percent compared with
the pre-vaccine years. However, in recent years, the United States has experienced a
reemergence, predominately due to unvaccinated children.
Nationally, pertussis cases and outbreaks are increasing. Among children, infants have the
highest incidence due to their lack of immunity, followed by children ages 7 to 10 years of age.
Children who are unvaccinated have more than an eightfold greater risk for pertussis than
children who are fully vaccinated with DTaP. Pertussis is a vaccine preventable disease whose
incidence can be significantly reduced through health education on the science of vaccine
protection.
Between 2005 and 2014, the number of reported cases of pertussis in Collier County adjusted
for population has increased from 1.6 to 6.2 per 100,000. This amounts to a 288 percent
increase in 10 years (Figure 9). Three fourths or 74 percent of the pertussis cases reported
since the year 2005 have occurred from 2010 to 2014. Contrasting with the total state’s reported
cases, Collier County has had on average higher incidence.
72
Data source: Florida Department of Health
Varicella
Varicella or chickenpox is an acute infectious disease caused by Varicella zoster virus (VZV).
Varicella occurs worldwide. In the pre-vaccine era, varicella was endemic in the United States,
and virtually all persons acquired the disease by adulthood. The mode of transmission is by
direct contact, person-to-person, droplet or airborne spread of vesicle fluid, or secretions of the
respiratory tract. In Florida, immunization against varicella is recommended for children
following their first birthday unless they have had the disease.
Varicella became a reportable disease in Florida in late 2006. Between 2007 and 2014, cases in
Collier County declined by 77 percent, in Florida cases decreased by 60 percent over the same
period (Figure 10).
0
1
2
3
4
5
6
7
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Figure 9. Number of Pertussis Cases per 100,000 Population,
Collier County and Florida, 2005–2014
Collier County
Florida
73
Data source: Florida Department of Health
0
5
10
15
20
25
2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Figure 10. Number of Varicella Cases per 100,000 Population,
Collier County and Florida, 2007–2014
Collier County
Florida
74
Animal Bites and Potential Exposures
Rabies is a preventable viral disease of mammals. It is transmitted when the virus is introduced
into a bite wound, an open cut in the skin or mucous membranes such as the mouth or eyes
after contact with a rabid animal. The most prevalent wild reservoirs of rabies in the United
States are raccoons, skunks, bats, foxes and coyotes. Domesticated mammals are also at risk
of acquiring rabies. Cats, cattle and dogs are the most frequently reported rabid domestic
animals within the United States. It should be emphasized that a rabid dog is a very rare event
in Florida and the United States.
Historically, few humans have survived animal rabies; statistically the disease is invariably fatal.
After a bite or exposure from a potentially rabid animal, the Florida Department of Health
provides intervention in the form of facilitating the administration of rabies post-exposure
prophylaxis (PEP). When administrated in a timely manner, rabies PEP can prevent persons
exposed to animal rabies from subsequently developing the disease.
Between 2005 and 2014, potential rabies exposures in Collier County increased by over 97
percent. The number of cases was highest from 2010 to 2012, peaking in 2011 with 351 animal
bites and potential exposures (Figure 11).
0
50
100
150
200
250
300
350
400
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Number of CasesYear
Figure 11. Number of Animal Bites and Potential Exposures Cases,
Collier County, 2005–2014
Data source: Florida Department of Health in Collier County, Epidemiology and Health Assessment Program
75
While heightened public health epidemiologic surveillance and vigorous investigations may
account for a portion of the realized increased in incidence, the rapid and extensive
development of land in Collier County has increased human to wild and stray animal contact.
Of the 1,698 animal bites and exposure cases reported in Collier County during this period,
about 32 percent of cases were recommended PEP. The percentage of cases where PEP was
recommended declined significantly between 2005 and 2011 (Figure 12). However, from 2012
to 2014, the percentage of PEP recommended cases increased significantly and was over 50
percent of all cases by 2014.
Data source: Florida Department of Health in Collier County, Epidemiology and Health Assessment Program
Of the all animal bites and exposures reported in Collier County, PEP and non-PEP
recommended cases during this period, dogs accounted for almost 63 percent of all reported
incidents, followed by cats with 19 percent, raccoons with 7.9 percent and bats with 4.7 percent.
Rodents, squirrels, foxes and skunks accounted for approximately 1 percent each (Figure 13).
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Percentage
Year
PEP
Non-PEP
Figure 12. PEP vs Non-PEP Recommended,
Collier County, 2005–2014
76
These distributions of bites and potential exposures by animals in Collier County are similar for
the state of Florida when ranked by frequency.
Data source: Florida Department of Health in Collier County, Epidemiology and Health Assessment Program
Over 95 percent of all reported animal bites and potential exposures identified the classification
of the animal involved in the incident. Over 59 percent of all cases involved domestic or
domestic owned animals, predominantly dogs. Approximately 19 percent involved feral or stray
animals, while 17 percent involved wild animals (Figure 14).
0%10%20%30%40%50%60%70%
Dog
Cat
Raccoon
Bat
Mouse/Rat
Squirrel
Other
Pig
Skunk
Unknown
Fox
Type of AnimalFigure 13. Type of Animal involved in Bites and Potential Exposures,
Collier County, 2005–2014
Percentage
77
Data source: Florida Department of Health in Collier County, Epidemiology and Health Assessment Program
Figure 15 displays the type of potential animal exposure in Collier County between 2011 and
2014. Approximately 85 percent of all reported cases occurred as animal bites, while only 5.4
percent were reported as scratch exposures, and 0.3 percent were mucous membrane
exposures. About 9 percent of all exposures were classified in the “other” category, which
includes animal non-bite/non-scratch related exposures.
59.2%
19.1%17.4%
4.3%
0%
10%
20%
30%
40%
50%
60%
Domestic/Domestic
Owned
Stray (feral)Wild UnknownPercentage
Classification of Animal
Figure 14. Classification of Animals involved in Animal Bites and Potential Exposures,
Collier County, 2005–2014
78
Data source: Florida Department of Health in Collier County, Epidemiology and Health Assessment Program
84.9%
5.4%
0.3%
9.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Bite Scratch Mucous Membrane
Exposure
OtherPercentage of Total ExposuresType
Figure 15. Classification of Potential Exposures,
Collier County, Florida, 2011–2014
79
Mosquito-Borne Diseases
Mosquito-Borne Diseases are an indigenous risk in Southwest Florida due to the geographical
location and climate. Collier County’s wet and warm season and conditions favor significant
breeding and propagation of the mosquito population.
There are five major mosquito-borne viruses which may be considered endemic to Florida and,
therefore, a potential public health concern in Collier County. While the actual annual risk of a
human contracting any mosquito-borne disease in Collier County is low, case fatality rates for
these diseases are high in comparison to most other infectious diseases found in Southwest
Florida. Because these five diseases are viral, antibiotics do not assist the treatment and
antiviral agents have not been shown to be effective.
Table 2 lists the five major mosquito-borne diseases of interest in Southwest Florida with the
number of cases reported in Collier County for the period 2005 to 2014.
Table 2. Mosquito-Borne Diseases, Collier County, 2005–2014
Disease 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005
EEE a) _ _ _ _ 4 _ _ _ _ _
WNV c) _ _ _ _ 2 _ _ _ _ _
SLEb) _ _ _ _ _ _ _ _ _ _
Malariac) _ _ _ 2 4 _ _ 2 3 2
Denguec) 2 1 1 _ 2 _ _ 2 _ _
Chikungunyac) 2 _ _ _ _ _ _ _ _ _
a) Equine cases
b) Last reported case of SLE in Collier County was in 1993 with a total of 3 cases
c) Imported cases
Data source: Florida Department of Health in Collier County, Epidemiology and Health Assessment Program
Eastern Equine Encephalitis (EEE) is a very uncommon disease in humans; however, it is one
of the most severe mosquito-borne disease. While only approximately one in every 23 persons
bitten by an infected mosquito may develop severe symptoms, about 33 to 45 percent of all
80
patients with clinical EEE symptoms will die from the disease. Most survivors will suffer from
significant brain damage. In Florida, only 85 sporadic cases in humans have been reported
between 1957 and 2013 for an average of 1.5 cases per year. Collier County has not reported a
human EEE case in public health history. Four equine cases of EEE were reported in Collier
County in 2010.
St. Louis Encephalitis (SLE) was the most common mosquito-borne human pathogen in the
U.S. before the introduction of West Nile Virus (W NV). In Collier County, SLE outbreaks last
occurred in 1990, 1993 and 1997. Less than one percent of SLE infected individuals are
symptomatic and the majority of infections remain unreported and undiagnosed. The case
fatality rate in Florida for SLE has ranged from four to 30 percent. Collier County did not report
any cases of SLE from 2005 to 2014.
West Nile Virus (WNV) was first detected in Florida in 2001; since then WNV activity has been
reported in every county in Florida. The first WNV case in Collier County was reported in 2002.
Of those infected, about 80 percent are asymptomatic infections, 20 percent have mild
symptoms, and less than one percent have a neuroinvasive infection. Two imported cases of
WNV were reported in Collier County in 2010.
Malaria was once endemic in Florida but eradicated in the late 1940s. Sporadic cases of Malaria
are still being reported in Florida; all associated to travelers returning from areas where Malaria
is endemic. From 2005 to 2014, 13 imported cases of Malaria were reported in the county, the
most of any other mosquito-borne disease.
Dengue fever is an important mosquito-borne disease globally that has begun to emerge in
parts of Florida. This disease is also known as “break-bone fever”, as symptoms are very painful
and debilitating. However, death due to dengue is uncommon. The infection is acquired through
the bite of specific species of mosquitoes: Aedes aegypti and Aedes albopictus. These two
species of mosquitoes are found in Florida and Collier County. In Collier County, there have
been a total of 8 reported imported dengue cases between 2005 and 2014.
In 2014, Chikungunya fever became a reportable disease in Florida. The first local transmission
of Chikungunya virus in the Americas was identified in the Caribbean in late 2013. Soon after, it
became a public health concern in Florida, as the introduction of the virus in the state was
imminent. The Chikungunya virus is transmitted by the same two species of mosquitos that
transmit dengue. Chikungunya fever is characterized by the sudden onset of high fever and
81
severe joint pain, and relapse of joint pain is common one to three months after initial symptoms
resolve. In 2014, approximately 426 imported cases and 12 locally-acquired cases of
Chikungunya fever were reported in Florida. Two imported cases were reported in Collier
County that year.
The Collier County Health Department continues to maintain active epidemiological surveillance
and vigilance while partnering with mosquito control to ensure that the probability of mosquito-
borne disease transmission remains low in the community.
82
Outbreaks
Any outbreak of a disease or condition found in the community or a setting that is of public
health significance is reportable by Florida administrative code. Outbreaks are investigated in
order to control them, to prevent transmission of the disease to others and to learn how to
manage and prevent similar outbreaks in the future. While all outbreaks are reportable, not all
diseases or conditions associated with outbreaks are diseases in themselves in the State of
Florida. In fact, the most common types of outbreaks in Collier County are associated with
diseases that are not reportable.
In 2014, 38 outbreaks were reported in Collier County. Approximately 19 outbreaks or 50
percent of outbreaks that year were associated with gastrointestinal illness (or norovirus) and
Influenza-like illness (ILI). Norovirus in particular has greatly affected the county during the 2005
to 2014 time period.
Norovirus
Noroviruses are a group of “Norwalk-like” viruses and the most frequent cause of acute
gastroenteritis illness in all age groups in the United States. Norovirus causes 19 to 21 million
cases of acute gastroenteritis in the U.S. annually. It is a highly contagious virus. The virus can
be transmitted from an infected person, contaminated food or water or by coming into contact
with contaminated surfaces. Norovirus spreads very quickly within closed places such as
daycare centers, nursing homes, schools and cruise ships. The majority of norovirus outbreaks
occur between November and April in the United States and Florida. The incubation period for
norovirus ranges from approximately 12 to 48 hours, and the average duration of illness is
between 24 and 72 hours. The disease is self-limiting for most people. While there is no specific
treatment available for norovirus, ill individuals should drink plenty of liquid to prevent
dehydration.
Figure 16 shows the number of suspected and confirmed norovirus outbreaks in Collier County
for the period 2007 to 2014. There were 58 norovirus outbreaks reported in Collier County
during this time period. Between January and April 2010, the community experienced a
tremendous surge in the number of norovirus outbreaks and related cases, resulting in the
highest incidence of the virus recorded locally in public health history. During this 4 month
83
interval, 16 outbreaks were reported from 12 different long term health care facilities in the
county.
Data source: Florida Department of Health in Collier County, Epidemiology and Health Assessment Program
4 6 7 16 1 9 6 9
0
2
4
6
8
10
12
14
16
18
2007 2008 2009 2010 2011 2012 2013 2014Number Of OutbreaksYear
Figure 16. Number of Confirmed and Suspected Reported Norovirus Outbreaks,
Collier County, 2007–2014
84
Tuberculosis
Tuberculosis (TB) is a mycobacterial disease that is a major cause of disability and mortality in
most of the world, especially developing and emerging countries. Initial infections usually go
unnoticed. Approximately 10 percent of the population infected will eventually develop active
disease; half of them during the first 2 years following infection. Ninety percent of untreated
individuals will never develop active tuberculosis. Tuberculosis mortality and morbidity rates
increase with age, and in older persons, the incidence rates are higher in males than in females.
Industrialized countries such as the United States showed downward trends of mortality and
morbidity of TB for many decades. As population from developing countries migrate to the
United States, the risk of potential disease transmission increases. In Florida, medically
underserved low-income populations, many of which are high-risk racial and ethnic minorities,
have a high rate of tuberculosis exposure and infection. These population groups
disproportionally represent the majority of TB cases in Collier County and the state.
Historically, the incidence of tuberculosis in Collier County has been higher than that of the state
of Florida. Only during select recent years have tuberculosis case rates in Collier been lower
than those of the state; however, this trend has not been consistent and reversed in 2010. This
was due to the various socioeconomic and epidemiological risk factors that surfaced during the
downturn in the local and national economies.
Although Collier County has had a number of successes over the past 20 years in decreasing
TB morbidity in select time periods, it still faces formidable challenges in preventing and
controlling tuberculosis in the community.
A total of 198 tuberculosis cases were reported in Collier County from 2005 to 2014, resulting in
an overall incidence rate of 6.2 per 100,000 population for the ten-year period. Figure 17 shows
the variation in the annual rate by year. The incidence rate of TB in Collier County has
experienced a significant decline of approximately 53 percent from 2005 to 2014, from the 7.5
per 100,000 population in 2010 to 3.5 per 100,000 population in 2014. Despite the decline in the
recent ten years, Collier County has had higher incidence rates than the State of Florida from
2005 to 2014.
85
Data source: Florida Department of Health in Collier County, Tuberculosis Program
Age, Gender, Race and Ethnicity
Among age groups, those between 25 to 34 years of age had the highest number of TB cases
in Collier County with 21.7 percent of all cases, followed by those between 35 and 44 years of
age with 20.2 percent of all cases. As for TB distribution by gender, as is expected, males
accounted for the majority of cases with 64.6 percent of all cases compared to females with
35.4 percent.
By race, 67 percent of the cases were among whites, 30 percent were black, while 4 percent
were categorized as “other races”. The distribution of TB among ethnicities is shown in Figure
18. Hispanics comprised the majority of cases in Collier County during the ten-year period.
From 2005 to 2014, Hispanics accounted for 53 percent of all reported cases of TB, whereas
Non-Hispanics accounted for 47 percent of all cases of TB. This distribution of TB among
ethnicities varies from the state of Florida and the national data; Hispanics accounted for less
0
2
4
6
8
10
12
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate
Year
Figure 17. Number of Tuberculosis Cases per 100,000 Population,
Collier County, 2005–2014
Rate
Average
86
than 30 percent of all TB cases in both Florida and the United States. This discrepancy is due to
ethnic distribution in Collier County, in which the Hispanic population is proportionally larger
than in the state of Florida and the United States.
Data source: Florida Department of Health in Collier County, Tuberculosis Program
HIV Co-Infection
Worldwide, tuberculosis is the leading cause of death for persons with HIV infection. A co-
infection with HIV complicates the treatment plan of TB. Both drug interactions and
malabsorption are challenges that must be overcome in the case management of co-infected
individuals. During the period 2005 to 2014, a total of 23 cases or 12 percent of cases in Collier
County were co-infected with HIV (Figure 19). During the same period, 15 percent or 1,258 TB
cases in Florida were co-infected with HIV.
0
3
6
9
12
15
18
21
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Number of CasesYear
Figure 18. Number of TB Cases by Ethicity, Collier County,2005–2014
Hispanic
Non Hispanic
87
Data source: Florida Department of Health in Collier County, Tuberculosis Program
Geographical Distribution
The distribution of a number of health conditions including tuberculosis and those related to
socioeconomic status, education, employment and income levels continues to be
disproportionate among different communities of the county.
Immokalee is a small agrarian community approximately 45 miles northeast of the city of
Naples; it is a major supplier of tomatoes and other produce to the United States. This type of
labor and life-style is historically and presently associated with poverty, public health risk and
vulnerable populations. While Immokalee accounts for anywhere between 6 and 8 percent of
the total county resident population at a given point in time, it accounted for almost 40 percent of
all tuberculosis cases between 2005 and 2014. The graph in Figure 20 displays the
disproportionate ethnic burden of tuberculosis in Immokalee.
0
1
2
3
4
5
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Number of CasesYear
Figure 19. Number of HIV Coinfected TB Cases, Collier County, 2005–2014
88
Data source: Florida Department of Health in Collier County, Tuberculosis Program
Collier County has had a number of successes over the past 20 years in decreasing TB
morbidity in select time periods. However, there remains a disproportionate burden of TB
among ethnic minorities as in the United States, and Collier County still faces formidable
challenges in preventing and controlling TB in the community.
59
48
17
72
0
10
20
30
40
50
60
70
80
Immokalee Greater Collier CountyNumber of CasesEthnicity
Figure 20. Number of TB Cases by Ethnicity,
Immokalee and Greater Collier County, 2005–2014
Hispanic
Non Hispanic
89
Sexually Transmitted Diseases (STDs)
Chlamydia
Chlamydia trachomatis infection is the most frequently reported notifiable disease in the United
States, Florida and Collier County. Chlamydia infections in women are usually asymptomatic
and can result in pelvic inflammatory disease (PID) which is a major cause of infertility, ectopic
pregnancy and chronic pelvic pain. As is the case with other inflammatory STDs, chlamydia
infections can facilitate the transmission of human immunodeficiency virus (HIV). Pregnant
women infected with chlamydia can also pass the infection to their infants during delivery,
potentially resulting in neonatal ophthalmic and pneumonia. Due to the burden of disease and
the risks associated with infections, CDC recommends that all sexually active women younger
than 25 years of age receive an annual chlamydia screening.
Between 2005 and 2014, the total number of reported chlamydia cases increased from 585 to
810, an increase of over 38.5 percent. Adjusted per 100,000 population, the rate increased by
23.7 percent from 191.2 to 236.6. Based on monitoring of case counts and the annualized rates
per 100,000 population, the morbidity trend is clearly on an upward slope (Figure 21).
Data source: Florida Department of Health in Collier County, STD Program
191.2 213.4 216.1
240.8 243.9
208.7 223.8
246.7 238.3 236.6
0
50
100
150
200
250
0
100
200
300
400
500
600
700
800
900
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Rate per 100, 000Number of CasesYear
Figure 21. Number of Reported Chlamydia Cases and Rates by Year, Collier County,
2005–2014
Number
Rate
90
Age and Gender. During the period of 2005 to 2014, the ratio of female to male cases of
chlamydia in Collier County ranged from 4.1 in 2005 to 2.1 in 2014. This variation in incidence
by sex is in keeping with national trends and its distribution. On average, the ratio of female to
male of reported chlamydia cases was 2.5 between 2005 and 2014. This implies that almost 3
times as many cases of chlamydia were reported in females compared to males in Collier
County. Sexually active females are at much greater risk of acquiring chlamydia than males.
From 2005 to 2014, the highest age-specific rates of reported chlamydia are in 20 to 24 years
age group for both females and males. The ratio of the female case rate to the male case rate
for this age group was 2.3. The second highest age-specific groups in Collier County were
among those 15 to 19 years of age, with females having almost 4.7 times the frequency as
males (Figure 22). Although not shown in the graph, the number of reported cases among those
55 years and older has increased sevenfold.
Data source: Florida Department of Health in Collier County, STD Program
0
500
1000
1500
2000
2500
15 - 19 20 - 24 25 - 29 30 - 34 35 - 39Number of CasesAge Group
Male
Female
Figure 22. Number of Reported Chlamydia Cases by Select Age Groups and Gender,
Collier County, 2005–2014
91
Race and Ethnicity. Figure 23 displays the distribution of reported chlamydia cases per 100,000
population in Collier County by gender and race. White females had the highest number of
chlamydia cases in the county with 4,030 cases, followed by white males with 1,468 cases,
black females with 1,042 cases and black males with 587 cases. However, when accounting for
population, black females had the highest number of cases per 100,000 with a rate of 954.6.
Data source: Florida Department of Health in Collier County, STD Program
While the Hispanic population of Collier County accounted for approximately 30 percent of the
total resident population in 2014, the number of Hispanic chlamydia cases were a
disproportionate 42 percent of all cases between 2005 and 2014. When rates per 100,000
population are analyzed, the Hispanic chlamydia rate increased by 4.1 percent during this
period, from 345.6 in 2005 to 359.7 per 100,000 for 2014. Although the chlamydia rate for the
non-Hispanic population increased by approximately 30 percent, the actual baseline rates for
non-Hispanics is about one-half the rate for Hispanics (Figure 24).
954.5
542.7
273.7
102.0
0
200
400
600
800
1000
1200
Black Female Black Male White Female White MaleRate per 100,000Gender and Race
Figure 23. Number of Reported Chlamydia Cases per 100,000 Population,
by Gender and Race, Collier County, 2005–2014
92
Data source: Florida Department of Health in Collier County, STD Program
Gonorrhea
Gonorrhea is caused by Neisseria gonorrhea, a bacterium that can grow and multiply easily in
warm, moist areas of the reproductive tract in both males and females. Gonorrhea can also
grow in the mouth, throat, eyes and anus. Gonorrhea is a very common communicable disease.
CDC estimates that more than 820,000 individuals get new gonorrheal infections each year.
However, due to under-reporting, less than 50% of these cases are reported annually
throughout the United States.
Between 2005 and 2014, 909 cases of gonorrhea were reported in Collier County. The annual
number has declined steadily from 123 in 2005 to 62 cases in 2014 with a decrease of 49.6
percent. The only variation that was observed in this pattern was an increase in reported cases
during 2006 and a slight increment in 2011 and 2012. Adjusted for population, the overall
gonorrhea reported case rate decreased by 52.7 percent between 2005 and 2014, from 38.3 to
18.1 per 100,000 population (Figure 25).
0
50
100
150
200
250
300
350
400
450
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Figure 24. Number of Reported Chlamydia Cases per 100,000 Population,
by Ethnicity, Collier County, 2005–2014
Hispanic
non-Hispanic
93
Data source: Florida Department of Health in Collier County, STD Program
Age and Gender. Unlike chlamydia where the risk of disease is much greater for females than
males, the risk of acquiring gonorrhea in Collier County appears to be equivalent on average for
both males and females. However, the age distribution pattern of gonorrhea cases in Collier
County is very similar to that of chlamydia, with the 20 to 24 years age group accounting for 35
percent of all reported cases for 2005 to 2014, followed by the 25 to 29 age group and 15 to 19
years of age (Figure 26).
38.3
46.7
30.1
28.3
22.3
22.1 24.7 25.5
20.2
18.1
0
10
20
30
40
50
0
20
40
60
80
100
120
140
160
180
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Rate per 100,000Number of CasesYear
Figure 25. Number of Reported Gonorrhea Cases and Rates by Year,
Collier County, 2005–2014
Number of Cases Rate
94
Data source: Florida Department of Health in Collier County, STD Program
Race and Ethnicity. White males had the highest number of gonorrhea cases in the county
with 357 cases, followed by white females and black males both with 199 cases and black
females with 126 cases. However, when accounting for population, black males had the highest
number of cases per 100,000 with a rate of 184 (Figure 27). Between 2005 and 2014, the
Hispanic gonorrhea rate decreased by 9.3 percent, while the rate for the non-Hispanic
population decreased by over 65.6 percent (Figure 28).
0
20
40
60
80
100
120
140
160
180
15-19 20 - 24 25 - 29 30 - 34 35 - 39Number of CasesAge Group
Male
Female
Figure 26. Number of Reported Gonorrhea Cases by Select Age Groups and Gender,
Collier County, 2005–2014
95
Data source: Florida Department of Health in Collier County, STD Program
115.4
184.0
13.5 24.8
0
50
100
150
200
Black Female Black Male White Female White MaleNumber of CasesGender and Race
Figure 27. Number of Reported Gonorrhea Cases per 100,000 Population,
by Gender and Race, Collier County, 2005–2014
0.0
10.0
20.0
30.0
40.0
50.0
60.0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Figure 28. Number of Reported Gonorrhea Cases by Ethnicity,
Collier County, 2005-2014
Hispanic
non-Hispanic
96
Syphilis
Syphilis is a genital ulcerative disease that causes significant complications if left untreated and
facilitates the transmission of HIV infection. Untreated early syphilis in pregnant women results
in perinatal mortality in as much as 40 percent of cases, and pregnancy may lead to infection of
the fetus in 80 percent of cases. Syphilis is passed from person to person through direct contact
with a syphilis sore. Sores occur on the external genitalia, vagina and anus or in the rectum.
These sores can also occur on the lips and in the mouth.
For the ten-year period of 2005 to 2014, the total number of reported syphilis cases in Collier
County ranged from a low of 16 in 2011 up to 69 in 2006. The overall syphilis case rate for this
time period was 13.2, and the rates ranged from 4.9 in 2011 to 22.7 per 100,000 population in
2006 (Figure 29). Trend analysis at the county level appears to indicate that overall syphilis is
declining on average over time; however, caution must be exercised in any statement of
conclusiveness as syphilis and the other STDs are known to be underreported in all
communities and jurisdictions in the US and Florida.
Data source: Florida Department of Health in Collier County, STD Program
0
10
20
30
40
50
60
70
80
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Number of CasesYear
Figure 29. Number of Reported Syphilis Cases, Collier County, 2005–2014
97
For the period of 2005 to 2014, 39 percent of the syphilis cases were latent syphilis of unknown
duration, 13.6 percent were late latent syphilis, 22.5 percent were early latent syphilis, 15
percent were secondary syphilis and 8.9 percent were classified as primary syphilis. Less than 1
percent of the cases were classified as congenital syphilis (Figure 30).
Data source: Florida Department of Health in Collier County, STD Program
Figure 31 shows the age and sex distribution of syphilis cases reported in Collier County over
the ten year period of 2005 to 2014. The differences in incidence by sex and age are clearly
evident in the graph. The distribution of syphilis cases in Collier County by sex is heavily
weighted towards males, 74 percent males compared to 26 percent for females. The peak for
male cases of syphilis occurred between 45 and 54 years of age, while the peak incidence
among females occurred between 30 and 34 years of age.
8.9%
15.0%
22.5%
13.6%
39.0%
0.9%
Figure 30. Reported Syphilis Cases by Type,
Collier County, 2005–2014
Primary Syphilis
Secondary Syphilis
Early Latent Syphilis
Late Latent Syphilis
Latent Syphilis Unknown Duration
Congenital Syphilis
98
Data source: Florida Department of Health in Collier County, STD Program
0
10
20
30
40
50
60
70
80
15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 54 55 - 64 65 and
OverNumber of CasesAge Group
Male
Female
Figure 31. Reported Syphilis Cases by Age Group and Gender, Collier County, 2005 –2014
99
HIV Infection
Historical Summary
In June 5, 1981, the Centers for Disease Control (CDC) published its first report of cases of
Pneumocystis carinii pneumonia (PCP) being diagnosed among previously healthy, young, gay
men in Los Angeles. This is the syndrome that would later become known as AIDS. The first
surveillance case definition for AIDS was published by the CDC in September of 1982. Soon
after this disease was recognized as a distinct syndrome, Florida began to collect voluntary
AIDS surveillance reports.
In 1983, the State of Florida Health Officer designated AIDS as a reportable disease, and a
formal AIDS surveillance program was instituted in the state. Mandatory reporting of AIDS was
incorporated into the Florida Statutes (s.384, F.S.) in 1986, and the Florida Administrative Code
(64D, F.A.C.) directed that all AIDS cases, as defined by the CDC, be reported to the local
county health department by physicians who diagnose or treat AIDS.
In 1993, the Centers for Disease Control published its first major revision of the AIDS case
definition. This change added three new AIDS-indicator diseases and allowed for HIV positive
individuals with severely depressed immune systems (those with an absolute CD4 count <200,
or <14%) to meet the AIDS case definition. This case definition revision went into effect
retroactively, and resulted in a substantial increase in the number of reported AIDS cases in
Florida.
The State of Florida passed legislation that became effective July 1, 1997. It authorized the
reporting of newly diagnosed cases of HIV infection by name (i.e. individuals who tested HIV+,
but did not meet the AIDS case definition). This legislation, however, did not allow for the
retroactive reporting of previously diagnosed HIV+ individuals.
Incidence and Prevalence
The first case of AIDS in Collier County was reported in 1982. Interestingly enough, the first
case of AIDS diagnosed in the county was not a gay male but rather a black female. As of
December 31, 2014, Collier County has reported 1,622 cases of HIV infection among its
residents. Of those infected with the virus and reported, 613 (37.8%) individuals are known to
100
have died, while 1009 (62.2%) are presumed still living. Treatment for HIV disease is both
widely available and effective. Most people with HIV survive long after their diagnosis.
Figure 32 displays the number of reported cases of HIV infection regardless of disease stage in
Collier County for the period of 1995 to 2014. In recent years, the number of reported new
cases of HIV infection has remained below 50 cases per year. In fact, the number of reported
HIV infection has decreased by approximately 40 percent from 2005 to 2014. From 2005 to
2014, 274 (55%) individuals met the AIDS case definition, with 221 (45%) still considered to be
HIV-positive only (individuals who have not yet progressed to AIDS). Due to advances in
medicine, people who were diagnosed with HIV/AIDS at an early age are now living longer.
Data source: Florida Department of Health in Collier County, HIV Program
Age and Gender
Persons diagnosed at age of fifty and over continue to constitute a significant proportion of local
cases. During the first 15 years of the HIV/AIDS epidemic, individuals age 50 and over
accounted for only 14 percent of reported cases in Collier County. In the 2005 to 2014 reporting
period, 26 percent of the reported cases were found in individuals 50 years old and over at their
55 56 69 82 66 59 107 72 73 80 49 82 57 65 47 47 49 43 35 30
0
20
40
60
80
100
120
1995 1997 1999 2001 2003 2005 2007 2009 2011 2013Number of CasesYear
AIDS Cases
Reports Only
New Cases of
HIV Infection
(Regardless of
AIDS Status)
Figure 32. Number of Reported Cases of HIV Infection (Regardless of Disease Stage),
Collier County, 1995–2014
101
time of their initial diagnosis. Often, persons in this age group do not consider themselves at risk
due to the persistence of stereotypes that HIV-infection is a young person’s disease.
Of those presumably living with HIV in the county, currently, 531 individuals or 53 percent are
over 50 years old. This presents its own set of challenges, both societal and medical, as this
population of individuals with HIV infection continues to age.
Between 2005 and 2014, 504 cases of HIV infection were reported in Collier County. Of those
cases, males account for 74 percent of the new cases, and females for 26 percent (Figure 33).
Women tended to be diagnosed at a slightly earlier age than men. Local data is somewhat
influenced by the tendency for women to present more often for care through the public health
system (family planning services, prenatal care, etc.) than men, and they have greater
opportunities to be tested for HIV infection.
Data source: Florida Department of Health in Collier County, HIV Program
75.7%
27.0%
Figure 33. Number of Reported Cases of HIV Infections, by Gender,
Collier County, 2005–2014
Male
Female
102
Race and Ethnicity
The distribution of HIV disease has been disproportionate among races and ethnicities, affecting
the minority populations in greater numbers. Factors that contribute to this include the increased
likelihood of poverty and lack of access to health care as well as cultural stigmas associated
with HIV risk behaviors. Figure 34 shows the distribution of the reported HIV infections by race
and ethnicity in Collier County for the years of 2005 to 2014. Blacks represented only 6.4
percent of the overall population (Figure 35). However, they accounted for 31.9 percent of the
reported HIV cases in the county for that time period. Likewise, Hispanics represented 27.8
percent of the population but accounted for 35.8 percent of the cases of HIV infection.
Data source: Florida Department of Health in Collier County, HIV Program
35.8%
31.3%
31.9%
1.0%
Figure 34. Number of Reported Cases of HIV infections, by Race and Ethnicity,
Collier County, 2005–2014
Hispanic
Non-Hispanic
White
Non-Hispanic
Black
Other
103
Data source: Florida Department of Health in Collier County, HIV Program
Geographical Distribution
Collier County has the largest surface area of any county east of the Mississippi River. The vast
majority of the population is concentrated along the Gulf Coast corridor. A sizeable population
also resides further inland to the east of the City of Naples. For the purposes of this report, this
entire area will be collectively referred to as the “Greater Naples Area”. From 2005 to 2014, 71.5
percent of all reported cases of HIV infection in Collier County have been reported from among
residents of this extensive area.
A second, smaller area of population density lies approximately 45 miles northeast of the City of
Naples; this is the community named Immokalee. This region is a major supplier of agricultural
produce, and the local economy is largely agriculture-based. Therefore, besides the permanent
resident population of Immokalee, there is also seasonal migration of agricultural workers in and
out of this community following employment opportunities.
27.8%
63.6%
6.4%
2.2%
Figure 35. Population Breakdown by Race and Ethnicity, Collier County, 2015 –2014
Hispanic
Non-Hispanic White
Non-Hispanic Black
Other
104
The Greater Naples and Immokalee areas of Collier County are often considered separately
because they reflect vastly divergent communities. Overall, there are significant disparities with
regard to racial composition, language, educational background, age and income between the
two population centers. Immokalee, both historically and currently, is home to a number of
vulnerable populations, which are subject to the effects of poverty, social pressures and other
public health issues.
Immokalee accounts for only approximately 7 percent of the total resident population of Collier
County. However, the Immokalee area accounts for 28.5 percent of all cases of HIV infection
reported in Collier County from 2005 to 2014 (Figure 36). Based upon population, Collier County
is the 16th largest county in Florida. At the close of 2014, among the 67 Florida counties, Collier
County was ranked 22nd in the number of HIV+ cases and 22nd in the number of AIDS cases
reported statewide.
Data source: Florida Department of Health in Collier County, HIV Program
71.5%
28.5%
Figure 36. Percentage Distribution of Reported Cases of HIV Infections,
by Geographical Area, Collier County, 2005 –2014
Greater
Naples Area
Immokalee
105
Maternal and Infant Health
Maternal health is the foundation for a vibrant and prosperous society. A healthy pregnancy and
the resulting birth of a healthy baby in a positive environment leads to an increase in the quality
of life for the mother, the child and the community.
Maternal related health outcomes are influenced by the health status and health behaviors of
the woman bearing the child as well as numerous other factors such as ethnicity, race, age,
education and income. The healthier the pregnancy the lower the probability of delivering an
infant with disorders or complications potentially resulting in unfavorable maternal outcomes or
infant mortality.
Infant mortality refers to deaths that occur during the first year of life-from a live birth through
age one. The rate is measured as the number of infant deaths per 1,000 live births within the
same specified calendar year.
106
The Infant Mortality Rate
The infant mortality rate, the number of deaths occurring in the first year of life out of every
1,000 live births, has been used for over a century as a gauge of the overall health status of the
nation, state and county and is frequently used for state to state and county comparisons by
various public health agencies and medical and health oriented academic and service
institutions. As of 2014, the infant mortality rate of the United States was 5.7, historically a low
rate for the nation yet still higher than 27 other European and Asian developed and
industrialized countries.
The infant mortality rate varies geographically by state and is associated and affected by a
myriad of factors which include: the education, income and age of the mother, the mother’s
health status during pregnancy and her access to healthcare. Southern states have the highest
infant mortality rates while states in New England and the Pacific Northwest have the lowest.
Research has determined that the higher rates in the southern states are likely to be explained
by the higher incidence of low birthweight outcomes and short gestational age births in these
states. The ethnic and racial composition of the population within a state or county directly
affects the level of the overall infant mortality rate due to the fact that certain racial and ethnic
groups are associated with higher levels of infant deaths. The level of infant mortality rate is
influenced by and correlated with the mother’s health and lifestyle behaviors, such as smoking,
drinking, diet, substance abuse, physical activity and access to and use of prenatal care.
As discussed in the section covering mortality, life expectancy at birth is heavily weighted by
infant mortality. Assuming actuarial methods used in the calculation of life expectancy, the lower
the infant mortality rate, the higher the average number of years a person can expect to live
when born.
Nationally, the infant mortality rate has remained the same or decreased every successive year
from 1990 through 2014 (the only exception being 2004).
107
Random Variation
As is the case with any statistical measure, the infant mortality rate is subject to chance or
random variation. If a county is relatively small in terms of the annualized number of live births,
and subsequently the annual number of infant death counts, then the annual observed infant
mortality rate will not be as stable as that same rate for a larger geographical area such as the
state. In the case of Collier County, the number of live births in 2014 were 3,288 which is 1.5
percent of the total number of live births for Florida for the same year, 219,905. In 2014, Collier
County experienced a total of 15 infant deaths, the number in the state of Florida for the same
year was 1,327. Collier County’s infant deaths accounted for 1.1 percent of the total number of
infant deaths in Florida.
When two geographical areas are compared in a given year (such as Collier County and
Florida) and one of the area’s rates is based on a relatively small number of live births (and
consequently a very small number of infant deaths), it is not unexpected to find the area with the
small number of events (infant deaths) to have its infant mortality rates vary in magnitude and
direction year to year, sometimes by as much as 100 percent. This statistical concept is
commonly referred to as random variation. For this reason, these types of comparisons should
not be made on a yearly basis alone. Time series trend analysis, preferably over at least a 10 to
20 year interval should be employed in order to monitor for “true” health outcome trends. Rolling
rates or averages will benefit in unmasking the actual direction and level of the rate and
superimposing a trend line is beneficial to interpreting the relative change of the health outcome
as well as the slope of the rates. Of all of the widely used public health statistics and indicators
monitored and analyzed within relatively smaller geographical or lesser populated areas, the
infant mortality rate is likely the most susceptible statistic to be influenced by small number
variability.
108
Infant Mortality
Between the period 2003 to 2005 and 2012 to 2014, the infant mortality rate for Collier County
declined by 21 percent to an average new low of 4.9 deaths per 1,000 live births. During this 10
year period, the highest rate occurred during 2008 to 2010, 6.6 per 1,000 live births. The infant
mortality rate for the State of Florida experienced a similar decline of 15 percent to a new low of
6.1 per 1,000 live births.
Figure 1 graphs the infant mortality rate for both Collier County and Florida for the period 2003
to 2005 and 2012 to 2014. Of particular note is the high degree of variability visible for Collier
County which is due to random variation as discussed on page two of this section. By inserting
a linear trend for Florida and Collier County in this graph as well as in other graphs that follow,
one is able to ascertain the progress accomplished over time or view when challenges are
present or emerging.
Data Source: Florida Department of Health, Bureau of Vital Statistics
Figures 2 and 3 show the infant mortality rates for Collier County and Florida by race for this ten
year interval. During this period the white infant mortality rate in Collier County decreased by 31
percent while the black infant mortality rate slightly increased by 15 percent. In Florida, the
corresponding declines were 18 percent and 20 percent, respectively. In Collier County a
0
1
2
3
4
5
6
7
8
2003-05 2006-08 2009-11 2012-14Rate per 1,000 Live BirthsYear
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 1. Number of Infant Death per 1,000 Live Births 3-Year Rolling Rates,
Collier County and Florida, 2003–2014
109
challenge does appear to be surfacing for the black population as their infant mortality rate has
actually been increasing since the year 2000.
Data Source: Florida Department of Health, Bureau of Vital Statistics
0
2
4
6
8
10
12
14
16
18
2003-05 2006-08 2009-11 2012-14Rate per 1,000 Live BirthsYear
Collier
County White
Collier
County Black
Collier
County White
Linear Trend
Collier
County Black
Linear Trend
Figure 2. Number of Infant Deaths per 1,000 Live Births 3-Year Rolling Rates by Race,
Collier County, 2003–2014
0
2
4
6
8
10
12
14
16
2003-05 2006-08 2009-11 2012-14Rate per 1,000 Live BirthsYear
Florida White
Florida Black
Florida White
Linear Trend
Florida Black
Linear Trend
Figure 3. Number of Infant Deaths per 1,000 Live Births 3-Year Rolling Rates by Race,
Florida, 2003–2014
110
In Collier County and the state of Florida, the Hispanic infant mortality rate is lower than that of
the non-Hispanic population. For 2012 to 2014, the Hispanic infant mortality rate in Collier
County was almost 32 percent lower than the non-Hispanic rate, 3.9 compared to 5.7 per 1,000
live births, respectively. Between the period, 2003 to 2005 and 2012 to 2014, the Hispanic infant
mortality rate decreased by 13 percent (Figures 4 and 5). These very low infant mortality rates
among the Hispanic population in Collier County are a reflection of healthy lifestyles and
behaviors on average among Hispanic females. These lower infant mortality rates also drive the
higher level of live expectancy at birth within the overall Hispanic population.
0
1
2
3
4
5
6
7
8
9
10
2003-05 2006-08 2009-11 2012-14Rate per 1,000 Live BirthsYear
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic
Linear Trend
Collier County
Non-Hispanic
Linear Trend
Figure 4. Number of Infant Deaths per 1,000 Live Births 3 -Year Rolling Rates by Ethnicity,
Collier County, 2003–2014
111
Data Source: Florida Department of Health, Bureau of Vital Statistics
0
1
2
3
4
5
6
7
8
9
10
2003-05 2006-08 2009-11 2012-14Rate per 1,000 Live BirthsYear
Florida
Hispanic
Florida Non-
Hispanic
Florida
Hispanic
Linear Trend
Florida Non-
Hispanic
Linear Trend
Figure 5. Number of Infant Deaths per 1,000 Live Births 3-Year Rolling Rates by Ethnicity,
Florida, 2003–2014
112
Prenatal Health and Lifestyle Behaviors
Access to prenatal care beginning with the 1st trimester and continuing throughout the
pregnancy is an essential component for a healthy baby and a successful maternal experience.
A pregnant women’s nutritional status and lifestyle behaviors such as tobacco and alcohol use
are all highly correlated with being able to give birth to a healthy and adequate weight infant.
Table 1 provides indicators on access to prenatal care and prenatal health and behaviors.
Between 2006a) and 2013b) the number of women 15–34 years with sexually transmitted
diseases per 100,000 population increased by less than 1 percent in Collier County while in the
state of Florida the rate increased by over 23 percent.
In Collier County, births to overweight mothers increased slightly by 12 percent while over 46
percent of mothers giving birth were either overweight or obese. During this same time period
the percentage of births born to mothers ages 15 to 19 years declined by 60 percent to 22.3.
Births to mothers older than 35 years of age also decreased to 4.2 percent of all live births
during 2009–2011. Births to unwed mothers ages 15 to 19 years increased during the four years
period by over 10 percent, while unwed mothers ages 20 to 54 years also gave birth more
frequently by 1 percent. In Collier County, pregnant women continued to improve their health
behaviors by decreasing their reliance on alcohol and tobacco use. Only 3 percent of mothers
who gave birth during 2012–2014 reported smoking during pregnancy, a decline of 30 percent
from 7 years prior.
Both multiple births and cesarean section births increased in incidence in Collier County in 2013
compared with 2006. C-section births increased by almost 10 percent while multiple births
increased by 31 percent.
Collier County lags behind Florida for all 3 indicators related to adequate prenatal care: births
with 1st trimester prenatal care, births with late or no prenatal care and births with adequate
prenatal care (Figure 6).
a) Indicators are for 2005–2007, b) Indicators are for 2012–2014
113
Table 1. Reported Prenatal Health and Behavioral Indicators, Collier County and Florida, 2005 –2007 and 2010–2014
2005–2007 2012–2014
Collier County Florida Collier County Florida
Rate Rate Rate Rate
Women 15–34 with sexually transmitted diseases, Per 100,000 1677.8 2105.6 1678.9 2599.9
Births to overweight mothers at time pregnancy occurred, percent 24.3 22.3 27.1 24
Births to obese mothers at time pregnancy occurred, percent 16.4 18 19.3 21.1
Births with inter-pregnancy interval < 18 months, percent 34.5 38 34.2 34.7
Births to mothers ages 15–19 years of age, per 1,000 population 55.1 43.1 22.3 24.3
Repeat births to mothers ages 15–19 years of age, percent 21.6 18.4 14.8 16.6
Births to mothers > 35 years of age, per 1,000 population 4.9 4.9 4.2 4.6
Births among unwed mothers ages 15–19 years of age, percent 81.8 86.9 90.1 91.2
Births among unwed mothers ages 20–54 years of age, percent 42.4 39.3 42.9 44.8
Births to mothers who report smoking during pregnancy, percent 4.3 7.5 3 6.5
C-section births, percent 36.6 36 40.2 37.7
Multiple births (twins, triplets or more), percent 2.6 3.2 3.4 3.3
114
Data Source: Florida Department of Health, Bureau of Vital Statistics
63.5
8.7
55.1
77
5.7
70.467.3
7.2
55
80.1
4.7
70.5
0
45
90
Births with 1st trimester
prenatal care
Births with late or no
prenatal care
Births with adequate
prenatal care (Kotelchuck
index)RateFigure 6. Rates in Access to Prenatal Care, Collier County and Florida,
2005–2007 and 2011–2013
Collier
County
Florida
Collier
County
Florida
2005-07
2011-13
115
Birth Outcomes
In public health within the United States as well as globally, birthweight of a newborn is
considered a vital indicator in the monitoring and evaluation of the state of the health situation of
a community, county and state. For public health assessment purposes birthweight is
dichotomized into: 1) Low birthweight (less than 2,500 grams or 5 pounds, 8 ounces and 2) Very
low birthweight (less than 1,500 grams or 3 pounds, 4 ounces).
Considered as a community predictor indicator of levels of infant morbidity and premature
mortality, low birthweight is more widely used in geographical health analyses since it is a more
common event and therefore lends itself to population based assessments.
Infants born with very low birthweight have a 24 percent chance of dying during their first year of
life. Mortality among low birthweight babies between 1,500 and 2,499 grams or 3 pounds, 4
ounces to 5 pounds, 8 ounces is significantly lower, at approximately one percent, which is still
a much higher rate than infants born above 2,500 grams, about 0.25 percent.
Risk factors among pregnant women for low birth weight outcomes include, maternal smoking,
low maternal weight gain or low pre-pregnancy weight, multiple births and violence and abuse
during pregnancy.
Lower birthweight increases the newborn’s likelihood of having a school-age learning disability
and impaired development. Infants born weighing less than 2,500 grams are more likely than
heavier infants to experience delayed motor skills.
Teenage pregnancy is correlated with low levels of prenatal care and pre-term delivery.
Pregnant teenagers have a higher likelihood of receiving no prenatal care or limited care as well
as achieving poor maternal weight levels. Births to teenage mothers are much more likely to
result in low birthweight deliveries when compared to older mothers in population based
assessments.
116
Low Birthweight
Low birthweight (less than 2,500 grams or 5 pounds, 8 ounces) and very low birthweight (less
than 1,500 grams or 3 pounds, 4 ounces) are statistical predictor variables of premature
mortality and of morbidity over a life span. Children born with a low birthweight status have a
higher incidence of growth and developmental problems and at a higher risk of cardiovascular
disease and respiratory syndromes throughout their lifetime.
Between 2005 and 2014, the percentage of live births with low weight increased by 2.9 percent
in Collier County and remained constant in Florida (Figure 7).
Data Source: Florida Department of Health, Bureau of Vital Statistics
One of the major root causes of this increase in low birthweight incidence over the 2005 to 2014
period has been the increase in the frequency of multiple births which in itself is associated with
a higher level of low birthweight. When comparing low birthweight incidence by race, Collier
County experienced a slight increasing trend in black low birthweight births during this 10 year
interval, while the trend for Florida held constant (Figures 8 and 9).
0
1
2
3
4
5
6
7
8
9
10
2005 2008 2011 2014Percentage of Live BirthsYear
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 7. Percentage of Live Births Under 2500 Grams (Low Birthweight),
Collier County and Florida, 2005–2014
117
Data Source: Florida Department of Health, Bureau of Vital Statistics
0
2
4
6
8
10
12
14
16
2005 2008 2011 2014Percentage of Live BirthsYear
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 8. Percentage of Live Births Under 2500 Grams (Low Birthweight) by Race,
Collier County, 2005–2014
0
2
4
6
8
10
12
14
16
2005 2008 2011 2014Percentage of Live BirthsYear
Florida White
Florida Black
Florida White
Linear Trend
Florida Black
Linear Trend
Figure 9. Percentage of Live Births Under 2500 Grams (Low Birthweight) by Race,
Florida, 2005–2014
118
By ethnicity, Hispanic low birthweight births in Collier County and in Florida increased between
2005 and 2014 (Figures 10 and 11).
Data Source: Florida Department of Health, Bureau of Vital Statistics
0
1
2
3
4
5
6
7
8
9
10
2005 2008 2011 2014Percentage of Live BirthsYear
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic
Linear Trend
Collier County
Non-Hispanic
Linear Trend
Figure 10. Percentage of Live Births Under 2500 Grams (Low Birthweight) by Ethnicity,
Collier County, 2005–2014
0
1
2
3
4
5
6
7
8
9
10
2005 2008 2011 2014Percentage of Live BirthsYear
Florida
Hispanic
Florida Non-
Hispanic
Florida
Hispanic
Linear Trend
Florida Non-
Hispanic
Linear Trend
Figure 11. Percentage of Live Births Under 2500 Grams (Low Birthweight) by Ethnicity,
Florida, 2005–2014
119
Teenage Births
Teenage pregnancy has been a priority area within public health for many decades. A birth to a
teenager is at higher risk of a low birthweight baby, preterm birth and infant death compared
with babies born to older mothers.
While teenage birth rates have been in a long term decline in the United States since the
1960’s, the U.S. teen birth rate remains one of the highest among all industrialized countries.
Teenage pregnancy is one of the few areas within the public health realm where currently in the
21st century the racial disparity gap is not as evident as in the infant mortality rate and the low
birthweight rate.
Between 2005 and 2014, the teenage birth rate for mothers 15–19 years of age declined by 61
percent in Collier County and by 48 percent in Florida (Figure 12).
Data Source: Florida Department of Health, Bureau of Vital Statistics
0
10
20
30
40
50
60
70
2005 2008 2011 2014Rate per 1, 000 PopulationYear
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 12.Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female Population,
Collier County and Florida, 2005–2014
120
Black teenagers in Collier County and Florida experienced a steeper decline than white
teenagers, 73 percent and 58 percent, respectively (Figures 13 and 14).
Data Source: Florida Department of Health, Bureau of Vital Statistics
0
10
20
30
40
50
60
70
80
2005 2008 2011 2014Rate per 1, 000 PopulationYear
Collier
County White
Collier
County Black
Collier
County White
Linear Trend
Collier
County Black
Linear Trend
Figure 13. Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female Population,by Race,
Collier County, 2005–2014
0
10
20
30
40
50
60
70
80
2005 2008 2011 2014Rate per 1, 000 PopulationYear
Florida White
Florida Black
Florida White
Linear Trend
Florida Black
Linear Trend
Figure 14. Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female Population, by Race,
Florida, 2005–2014
121
Hispanic teenagers 15–19 years of age also experienced a more significant decrease in rates,
61 percent in Collier County and 43 percent in Florida (Figure 15 and 16).
Data Source: Florida Department of Health, Bureau of Vital Statistics
0
20
40
60
80
100
120
2005 2008 2011 2014Rate per 1, 000 PopulationYear
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic
Linear Trend
Collier County
Non-Hispanic
Linear Trend
Figure 15. Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female Population, by
Ethnicity, Collier County, 2005–2014
0
10
20
30
40
50
60
70
2005 2008 2011 2014Rate per 1, 000 PopulationYear
Florida
Hispanic
Florida Non-
Hispanic
Florida
Hispanic
Linear Trend
Florida Non-
Hispanic
Linear Trend
Figure 16. Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female Population, by
Ethnicity, Florida, 2005–2014
122
Repeat births to teenage mothers 15–19 years decreased in Collier County and Florida between
2005 and 2014 by 26 and 12 percent, respectively (Figure 17).
Data Source: Florida Department of Health, Bureau of Vital Statistics
By race, repeat births to teenage mothers dropped dramatically in Collier County among blacks
and whites, −25 percent and −17 percent, respectively, from 21.4 to 16.1 for whites and from
25.5 to 21.1 for blacks. In Florida, the repeat birth rate to white teenage mothers declined
slightly from 17.6 in 2005 to 15.8 in 2014, while the rate for blacks decreased by 15 percent
from 21.6 to 18.4 (Figures 18 and 19). In Collier County, the trend for Hispanic and non-
Hispanic repeat teenage births was an almost parallel decline of 16 percent and 45 percent,
respectively. In Florida, Hispanic repeat teenage births declined by 27 percent while non-
Hispanic repeat teenage births declined by 36 percent (Figures 20 and 21).
0
5
10
15
20
25
2005 2008 2011 2014Percent of Total Births 15–19 Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 17.Repeat Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female
Population, Collier County and Florida, 2005–2014
123
Data Source: Florida Department of Health, Bureau of Vital Statistics
0
5
10
15
20
25
30
35
2005 2008 2011 2014Percent of Total Births 15–19 Year
Collier
County White
Collier
County Black
Collier
County White
Linear Trend
Collier
County Black
Linear Trend
Figure 18. Repeat Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female Population,by
Race, Collier County, 2005–2014
0
5
10
15
20
25
2005 2008 2011 2014Percent of Total Births 15–19 Year
Florida White
Florida Black
Collier
County White
Linear Trend
Collier
County Black
Linear Trend
Figure 19. Repeat Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female Population,
by Race, Florida, 2005–2014
124
Data Source: Florida Department of Health, Bureau of Vital Statistics
0
5
10
15
20
25
30
2005 2008 2011 2014Rate per 1, 000 PopulationYear
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic
Linear Trend
Collier County
Non-Hispanic
Linear Trend
Figure 20. Repeat Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female Population, by
Ethnicity, Collier County, 2005–2014
0
5
10
15
20
25
2005 2008 2011 2014Rate per 1, 000 PopulationYear
Florida
Hispanic
Florida Non-
Hispanic
Florida
Hispanic
Linear Trend
Florida Non-
Hispanic
Linear Trend
Figure 21. Repeat Births to Teenage Mothers Ages 15–19 Rates per 1,000 Female Population, by
Ethnicity, Florida, 2005–2014
125
Maternal Mortality
Maternal death is a relatively rare event in the United States with approximately 650 women
dying each year as a result of their pregnancy or complications during delivery. While numerous
factors influence the health outcome of a pregnancy, it is very crucial that women of
reproductive age adopt and maintain healthy life styles before and during their pregnancy as
well as receive routine prenatal care and attention throughout gestation.
Between 2005 and 2007, Collier County did not experience any maternal deaths. During 2008,
2009, 2011, 2012, 2013 and 2014 between 1 and 3 maternal deaths occurred annually thereby
increasing the rates for those years to very high levels due to the concept of small number
random variation discussed earlier in this section (Table 2).
One maternal death is a sentinel event which triggers a comprehensive investigation regarding
its root cause at the county level.
Table 2. Number of Maternal Deaths per 100,000 Live Births, Single Year Rates,
Collier County and Florida, 2005–2014
Collier Florida
Years Rate Rate
2005 0.0 23.0
2006 0.0 14.8
2007 0.0 20.1
2008 53.5 13.8
2009 28.3 26.2
2010 0.0 20.5
2011 31.3 22.0
2012 95.3 20.2
2013 31.7 29.7
2014 30.4 21.4
Data Source: Florida Department of Health, Bureau of Vital Statistics
126
Analysis of Infant Mortality, Low Birth Weight and entry Into Prenatal Care in
Collier County, 2005–2014
This analysis covers the 10-year time period between 2005 and 2014, which allows for a time
series or trend analysis which draws a precise picture of the present situation and the recent
past. Analyses of one year, or of a time period of less than ten years, usually do not accurately
depict the situation due to the random variation of small numerators and/or denominators as
well as socioeconomic and social trends affecting health outcome indicators and statistics. The
following reflects the situation as of December 31, 2014, and it is hoped that this analysis will
become a foundation for further investigation in order to improve prenatal and maternal care in
Collier County.
With very few exceptions, all population based maternal and infant health outcomes and
indicators are associated with the level of education of the mother which inevitably is highly
correlated with median income and other socioeconomic status indicators.
With higher median income levels, on average, the result is healthier lifestyles and a greater
awareness of the socioeconomic factors leading to a healthier family and community. In other
words, on average and in population based aggregates, the higher the education, the lower the
infant mortality rate and the higher life expectancy and the quality of life. Exceptions to this do
occur; however in public health, we deal with the total population of a state, county or
community and outliers do not affect the overall population based health outcome indicators
given a valid sample size. We should always remember that infant mortality affects life
expectancy as it occurs during the first year of life which results on average in over 70 years of
potential life lost per infant death. Maternal health and the trimester of entry into prenatal care is
directly related to the education level and the awareness of the pregnant mother regarding
healthy behaviors and choices.
When analyzed by 1st and 2nd trimester entry into prenatal care, non-Hispanics and non-
Haitians achieved 87.1 percent, Hispanics 85 percent and Haitians 82 percent, respectively. For
entry by the 1st trimester, Hispanics are at almost 56 percent and Haitians at 50.2 percent,
while non-Hispanics and non-Haitians are at 68.5 percent. There are more pregnant women
with unknown trimester of entry into care than those entering in the 3rd trimester for Haitians
and non-Hispanics, non-Haitians (Figure 22).
127
1st Trimester1st Trimester1st Trimester1st Trimester2nd Trimester2nd Trimester2nd Trimester2nd Trimester3rd Trimester3rd Trimester3rd Trimester3rd TrimesterNo Prenatal CareNo Prenatal CareNo Prenatal CareNo Prenatal CareUnknown Care StatusUnknown Care StatusUnknown Care StatusUnknown Care Status0
10
20
30
40
50
60
70
Total All Ethnicities Hispanic Haitian Non-Hispanic Non-HaitianPercentageFigure 22. Percentage Distribution of Live Births by Trimester Prenatal Care Began, by Ethnicity,
Collier County, 2005–2014
128
Comparing all ethnic groups, it is clear that the average Haitian infant mortality rate (IMR)
is significantly higher compared with Hispanics and non-Hispanics, non-Haitians as well
as highly variable.
This is a good example of statistical random variation of small numerators and
denominators that will inevitably result in a volatile rates in some years and unstable
trends over time (Figure 23).
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 1,000 Live BirthsYear
Figure 23. Number of Infant Deaths per 1,000 Live Births, by Ethnicity,
Collier County, 2005–2014
Hispanic
Haitian
Non-Hispanic
Non-Haitian
129
The Hispanic IMR is in a declining trend and also exhibits some random variation (in
2006 the IMR was 6.9, in 2008, 5.7).
This is an excellent example as to the reason why we analyze at least 10 years’ worth of
data, the IMR was 4.2 in 2005 and declined to 4.0 in 2014—a slight 4.8 percent decrease
yet in four of these ten years the Hispanic IMR was lower than the beginning point of 4.2
in 2005 (Figure 24).
0
1
2
3
4
5
6
7
8
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 1,000 Live BirthsYear
Figure 24. Linear Trend of the Number of Infant Deaths per 1,000 Live Births, by
Ethnicity, Collier County, 2005–2014
Hispanic
Hispanic
Linear
Trend
130
The trend for the IMR among Haitians is on a declining slope (improving) although it is
still at a much higher level than the other ethnic groups. However, if it were not for the
extremely high IMR in 2009 (22.0) the trend would be more or less constant (IMR was
9.7 in 2006 and 10.8 in 2014) (Figure 25).
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 1,000 Live BirthsYear
Figure 25. Linear Trend of the Number of Infant Deaths per 1,000 Live Births,
by Ethnicity, Collier County, 2005–2014
Haitian
Haitian
Linear Trend
131
The IMR among the non-Hispanic, non-Haitians is also in a downward slope of
improvement, from 5.7 in 2005 to 4.0 in 2014 (Figure 26).
When analyzing data on low birth weight by ethnicity it is clear that the Haitian live births
have a significantly higher percentage of being born under 2500 grams than the other
ethnic entities. Figure 27 will visually depict these differences.
0
1
2
3
4
5
6
7
8
9
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 1,000 Live BirthsYear
Figure 26. Linear Trend of the Number of Infant Deaths per 1,000 Live Births, by
Ethnicity, Collier County, 2005–2014
Non-Hispanic
Non-Haitian
Non-Hispanic
Non-Haitian
Linear Trend
132
0
2
4
6
8
10
12
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Percentage
Year
Figure 27. Distribution of Live Births, by Ethnicity and Low Birthweight, Collier County, 2005 –2014
Hispanic Haitian Non-Hispanic Non-Haitian Total All Ethnicities
133
Figure 28 clearly indicates that Hispanics consistently (with the exception of 2014) experience
lower low birth weight levels than all of the three groups being analyzed.
On average, Haitians have just under twice the percentage of low birth weight live births as
Hispanics. It is also important to view these data within the context of the total live birth
population of Collier County.
In 2014 there were a total of 3,288 resident live births recorded in Collier County (provisional
data) of which 278 or 8.5 percent were of Haitian ethnicity, 1,503 or 45.7 percent were of
Hispanic ethnicity and 1,507 or 45.8 percent were of non-Hispanic, non-Haitian origin.
Approximately one out of every twelve live births in Collier County is of Haitian ethnicity while
one out of every two is of Hispanic ethnicity as well as those of non-Hispanic, non-Haitian origin.
0
2
4
6
8
10
12
2005 2008 2011 2014Percentage
Year
Figure 28. Distribution of Live Births, by Ethnicity and Low Birth Weight,
Collier County, 2005–2014
Hispanic Haitian Non-Hispanic Non-Haitian Total All Ethnicities
134
It is clear that the trend line for low birth weight births among Hispanics in Collier County has
been increasing at a slight slope from 2005 to 2014 (Figure 29).
0
1
2
3
4
5
6
7
8
2005 2008 2011 2014Percentage
Year
Figure 29. Linear Trend of the Distribution of Live Births, by Ethnicity and Low Birth
Weight, Collier County, 2005–2014
Hispanic
Hispanic
Linear Trend
135
Figure 30 indicates that the trend for low birth weight live births among the Haitian population in
Collier County has been fairly constant with a faint trend upward between 2005 and 2014.
0
2
4
6
8
10
12
14
2005 2008 2011 2014Rate per 1,000 Live BirthsYear
Figure 30. Linear Trend of the Distribution of Live Births, by Ethnicity and Low Birth
Weight, Collier County, 2005–2014
Haitian
Haitian
Linear
Trend
136
Between 2005 and 2014 the trend for low birth weight live births among non-Hispanics and non-
Haitians decreased slightly by approximately 5 percent (Figure 31).
0
1
2
3
4
5
6
7
8
9
10
2005 2008 2011 2014Percentage
Year
Figure 31. Linear Trend of the Distribution of Live Births, by Ethnicity and Low Birth
Weight, Collier County, 2005–2014
Non-Hispanic
Non-Haitian
Non-Hispanic
Non-Haitian
Linear Trend
137
Injuries
Injuries affect the entire population regardless of age, gender, ethnicity, race or socioeconomic
status. The majority of all injury deaths at every age are unintentional. Unintentional injury is
now the fourth leading cause of death in Collier County, accounting for almost 6 percent of all
deaths annually.
The risk of mortality due to an injury will vary by age, gender and the external cause. Males
have significantly higher death rates from injuries than females at any age group, while people
65 years and older have a much greater injury fatality rates than those 64 years and younger.
The risk of death from any external cause rises exponentially beginning around 70 years of age.
The external causes of injury deaths vary distinctly by age. For adults 35 to 44 years of age,
poisoning is the leading cause of injury mortality. The leading cause of injury deaths in the older
population is falls, while motor vehicle crash deaths are the leading cause of injury mortality for
all other age aggregates combined.
Mortality trends from injuries vary depending on the external causes of the injury. Some select
causes have declined over time and maintained a constant level, while other causes are still
rising annually. A concerning trend over the last 30 years had been the dramatic growth in
poisoning deaths; however, over the last decade, poisoning deaths have declined annually.
Motor vehicle traffic mortality rates have been declining over the past three decades. While
many other causes of injury mortality have been decreasing over the past decades, death rates
from falls have started to accelerate over the past 10 years. An important component of this
tremendous surge in mortality from falls is the rapidly growing baby-boomer cohort coupled with
the increased levels of life expectancy.
All of these causes of injuries are theoretically preventable, therefore granting the opportunity
and challenge to reduce Years of Potential Life Lost (YPLL) and increase life expectancy at
various ages.
138
Injury Mortality in Collier County
Unintentional injuries comprise a leading cause of death for all ages in Collier County and
Florida; however, the leading cause of unintentional injuries deaths within select age groups
varies with the actual external cause of injury.
Figure 1 shows the age-specific death rates per 100,000 population for the leading causes of
injuries in Collier County for 2012 to 2014. At first glance, it is apparent that falls begin at ages
75 to 84 years, as the rate rises exponentially to over 500 per 100,000 population at ages 85
years and over. Because of the vertical scale in Figure 1, the effect of other causes of injury
deaths, which have rates below 50 per 100,000 population, is difficult to analyze.
In Figure 2, the vertical scale has been adjusted to only extend to 90 per 100,000 population.
This was done in order to:
show the dramatically sharp increase in the mortality rate from falls for the 75 to 84 age group,
and
allow for motor vehicle injuries deaths, unintentional poisoning deaths and drowning deaths to
be visually and measurably depicted in the graph.
It is now clear that the increase in the mortality rate from falls in the 75 to 84 years age group is
highly significant as is the mortality rate in the 85 years of age and older age group.
Deaths from motor vehicle injuries are highest between the ages of 15 to 34 years of age.
Historically, this has been the case particularly among males. Deaths from unintentional
poisonings have relatively high mortality rates between the ages of 15 to 64 years of age. Most
of these deaths are related to illegal drug and prescription drug abuse. Death rates from
drowning predominantly occur in Collier County in the vulnerable 1–4 years and the 85 years
and over age groups.
Neither deaths from homicide by firearms or homicide by other means have mortality rates that
stand out. Homicide by firearm mortality rates in Collier County appear to currently be clustered
in age groups 15 to 44 years of age.
139
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
100
200
300
400
500
600
<1 1-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+Rate per 100,000Age Group
Motor Vehicle
Accidents
Drowning and
Submersion
Poisoning
Homicide by
Fire Arms
Homicide by
Other Means
Falls
Figure 1. Number of Deaths for Leading Causes of Injuries per 100,000 Population, by Age,
Collier County, 2012–2014
0
10
20
30
40
50
60
70
80
90
<1 1-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84Rate per 100,000Age Group
Motor Vehicle
Accidents
Drowning and
Submersion
Poisoning
Homicide by Fire
Arms
Homicide by
Other Means
Falls
Figure 2. Number of Deaths for Leading Causes of Injuries per 100,000 Population, 0 -84 Years of Age,
Collier County, 2012–2014
140
During the period of 2005 to 2014, the mortality rate in Collier County decreased by
approximately 22 percent with a downward trend line (Figure 3). This trend can be attributed
mainly to the decline in fatal motor vehicle collisions. Florida’s mortality rate declined by just
under 6 percent from 2005 to 2014.
Figure 4 shows the mortality rates for all injuries in Collier County for 1990, 2000 and 2014. All
of the three points in time have similar age-specific distributions from age 1 to 74. In 2014, the
mortality rate due to all injuries increased exponentially beginning with the 75 to 84 age group.
This will be analyzed further when deaths from falls are examined.
In Collier County, the mortality trend for injuries for males and females has been slowly moving
down over the 10 year period; however, the trend for males is decreasing at a slightly faster
pace than females (Figure 5). The trend for the death rate for all injuries In Florida has remained
constant for both males and females over the 2005 to 2014 period.
The mortality rates from all injuries by race for Collier County between 2005 and 2014 can be
observed in Figure 6. While there is variability in the black injuries mortality rates, the trend is
upward, surpassing the white injuries mortality rate in 2014. The white injuries mortality rate
showed a downward trend for this time period with a 24 percent decrease. In the state of
Florida, the black and white injuries mortality rates have parallel downward linear trends over
the past 10 years with mortality rates being higher among whites.
Both the Hispanic and the non-Hispanic mortality rates in Collier County have been trending
downward since 2005 at parallel slopes, with non-Hispanics having the higher rates (Figure 7).
In Florida, the trend for the Hispanic and the non-Hispanic populations have remained fairly
constant.
141
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
100
200
300
400
500
600
700
1-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+Rate per 100,000Age Group
Figure 4. Number of Deaths from all Injuries per 100,000 Population, by Age,
Collier County, 1990, 2000 and 2014
Collier
County
Injuries-
1990
Collier
County
Injuries-
2000
Collier
County
Injuries-
2014
0
10
20
30
40
50
60
70
80
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 3. Number of Deaths from all Injuries per 100,000 Population,
Collier County and Florida, 2005–2014
142
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
20
40
60
80
100
120
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County Male
Collier
County
Female
Collier
County Male
Linear Trend
Collier
County
Female
Linear Trend
Figure 5. Number of Deaths from All Injuries per 100,000 Population, by Sex,
Collier County, 2005–2014
0
20
40
60
80
100
120
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County White
Collier
County Black
Collier
County
White Linear
Trend
Collier
County Black
Linear Trend
Figure 6. Number of Deaths from All Injuries per 100,000 Population, by Race,
Collier County, 2005–2014
143
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
10
20
30
40
50
60
70
80
90
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Hispanic
Collier
County Non-
Hispanic
Collier
County
Hispanic
Linear Trend
Collier
County Non-
Hispanic
Linear Trend
Figure 7. Number of Deaths from All Injuries per 100,000 Population by Ethnicity
Collier County, 2005–2014
144
Motor Vehicle Crashes
Figure 8 displays the number of deaths from motor vehicle crashes per 100,000 population for
Collier County and Florida for the period 2005 to 2014. During this 10 year period, the death
rate in Collier County declined significantly by over 42 percent, and in Florida the rate declined
by about 37 percent.
In all counties of Florida and the United States, male mortality from motor vehicle crashes has
historically been, and remains, significantly higher than that of females. The dominating root
causes of higher male mortality are risky driving behavior and the lack of both seat belt and
motorcycle helmet use. Figure 9 shows the motor vehicle crash mortality rates by sex for Collier
County. Even though death rate for males at baseline was much greater than that of females,
the rate for males is exhibiting a much steeper decline. The mortality rate for males declined by
over 61 percent, whereas for females the rate declined by about 36 percent.
From 2005 to 2014, the mortality rate of the white population in Collier County declined by over
49 percent, while the rates for the black population in Collier County displayed too much
excessive variability to provide meaningful analyses (Figure 10). Florida’s mortality rates for
whites during the 10 year period decreased by 37 percent, while the rates for blacks declined by
33.7 percent.
The mortality rate from motor vehicle crashes among Hispanics in Collier County declined
sharply between 2005 and 2014, while this rate in non-Hispanics has remained constant (Figure
11). The mortality rate of both whites and blacks throughout the state has declined over the 10
year period.
A comparison among years 1990, 2000 and 2014 of deaths from motor vehicle crashes in
Collier County by age groups can be observed in Figure 12. During 2014, the highest mortality
rates occurred at ages 15 to 19, 25 to 34, 45 to 54, and 85+. The rates among most age groups
are lowest for 2014 compared to 1990 and 2000. These data confirm that various auto and
transport oriented interventions, such as speed enforcement and DUI programs are having a
positive result of reducing deaths on the streets and highways of Collier County.
145
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida Linear
Trend
Figure 8. Number of Deaths from Motor Vehicle Crashes per 100,000 Population,
Collier County and Florida, 2005–2014
0
5
10
15
20
25
30
35
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 9. Number of Deaths from Motor Vehicle Crashes per 100,000 Population, by Sex,
Collier County, 2005–2014
146
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
5
10
15
20
25
30
35
40
45
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 10. Number of Deaths from Motor Vehicle Crashes per 100,000 Population, by Race
Collier County, 2005–2014
0
5
10
15
20
25
30
35
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 11. Number of Deaths from Motor Vehicle Crashes per 100,000 Population, by Ethnicity
Collier County, 2005–2014
147
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
10
20
30
40
50
60
70
80
90
100
5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84 85+Rate per 100,000Age Group
Figure 12. Number of Deaths from Motor Vehicle Crashes per 100,000 Population, by
Age, Collier County,1990, 2000 and 2014
Motor Vehicle
Crashes
Death Rate-
1990
Motor Vehicle
Crashes
Death Rate-
2000
Motor Vehicle
Crashes
Death Rate-
2014
148
Unintentional Poisoning
Prior to 2005, there had been dramatic growth in unintentional poisoning deaths for 30 years in
Collier County and Florida. Between 2005 and 2014, an evident decrease (42.9 percent
decrease) of the death rates from unintentional poisoning was observed in Collier County,
whereas the rate in Florida stabilized (Figure 13).
From 2005 to 2014, the death rate In Collier County for males decreased by 28.6 percent, and
the death rate for females also declined significantly with a 72.6 percent decrease (Figure 14).
Florida males experienced a slight decrease of 5.7 percent in mortality rate; whereas Florida
females experienced an increase of 21.7 percent.
Whites in Collier County experienced mortality-rate decreases of 47.8 percent over the 10 year
period of 2005 to 2014. There were not enough frequency counts for blacks in Collier County to
ascertain the percent change; however, the trend for the population has been upward for the
time interval analyzed (Figure 15). Throughout the state, the mortality rate of whites and blacks
remained constant for the 10-year period; however, whites had rates twice as high as the
blacks.
In Collier County, Hispanic deaths from poisonings remained constant between 2005 and 2014,
while non-Hispanic deaths from this cause decreased by 51.8 percent. However, non-Hispanics
had a much higher baseline than Hispanics (Figure 16). In Florida, both non-Hispanic and
Hispanic mortality rates remained constant, with non-Hispanics more than doubling the Hispanic
mortality rate for the period of 2005 to 2014.
Of particular interest is the significant increase in mortality in Collier County during 2014 due to
this cause when compared with years 1990 and 2000 (Figure 17). Of major concern are the
death rates in those 25 to 54 years of age and 75 years and older. These age groups have
mortality rates that are beyond historical limits.
149
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear Trend
Florida
Linear Trend
Figure 13. Number of Deaths from Unintentional Poisoning per 100,000 Population,
Collier County and Florida, 2005–2014
0
5
10
15
20
25
30
35
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 14. Number of Deaths from Unintentional Poisoning per 100,000 Population , by Sex,
Collier County, 2005–2014
150
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
5
10
15
20
25
15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84Rate per 100,000Age Group
Figure 17. Deaths from Unintentional Poisoning per 100,000 Population
by Age, Collier County, 1990, 2000, and 2014
Poisoning
Death Rate-
1990
Poisoning
Death Rate-
2000
Poisoning
Death Rate-
2014
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 15. Number of Deaths from Unintentional Poisoning per 100,000 Population , by Race,
Collier County, 2005–2014
0
5
10
15
20
25
30
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 16. Number of Deaths from Unintentional Poisoning per 100,000 Population , by Ethnicity,
Collier County, 2005–2014
151
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
5
10
15
20
25
15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84Rate per 100,000Age Group
Figure 17. Number of Deaths from Unintentional Poisoning per 100,000 Population
by Age, Collier County, 1990, 2000 and 2014
Poisoning
Death Rate-
1990
Poisoning
Death Rate-
2000
Poisoning
Death Rate-
2014
152
Drownings
For both the county and the state, the mortality rate from drowning has been slowly trending
downward since 2005 (Figure 18). The range of mortality rates in Collier County was a high of
4.8 in 2007 and a low of 0.8 100,000 population in 2014. It should be kept in mind that
drownings in Collier County are fortunately rare events; the counts or total numbers of deaths
due to this external cause of death are low compared to many other fatal injuries. In Florida, the
mortality rate ranged from a high of 2.2 in 2006 to a low of 1.8 per 100,000 population in 2011 to
2013.
Figure 19 shows the age-specific death rates for drowning deaths in Collier County for the years
1990, 2000 and 2014. These data describe a decrease in the drowning death rates since 1990
for ages 1–4, 35–44, 55–64 and 65–74 years of age. Increases in this mortality rate are visible
for the 10–19 age groups as well as the 75–84 age groups.
Although random variation caused dramatic fluctuations in the rates from year to year, the death
rate from drownings for males in Collier County has been trending downwards over the last 10
years. This trend has been fairly constant over the 2005 to 2014 period (Figure 20). Florida
exhibited a slight downward trend among males, while females displayed a constant trend.
Although downward trends can be observed in Figure 21 for both whites and blacks in Collier
County, an analysis of the rates for these years would not be pertinent due to low counts and
random variation. In Florida, the rate for the black population has been constant over the time
interval, whereas the rate of the white population has slightly decreased.
As can be seen in the Figure 22, highly variable fluctuations occurred for both the Hispanic and
the non-Hispanic population in the county resulting in downward trends for the non-Hispanic
drowning mortality rate. As with all drowning data for Collier County, small numbers of events
can result in dramatic differences year to year. Florida’s drownings mortality rate among non-
Hispanics showed stable and constant trends; however, the rate among Hispanics experienced
a 10.5 percent decline.
153
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
1
2
3
4
5
6
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Florida
Collier County
Linear Trend
Florida Linear
Trend
Figure 18. Number of Deaths from Drownings per 100,000 Population,
Collier County and Florida, 2005–2014
0
10
20
30
1-4 5-9 15-19 35-44 45-54 55-64 65-74Rate per 100,000Age Group
Figure 19. Deaths from Drownings per 100,000 Population, by Age,
Collier County, 1990, 2000 and 2014
Drowning Death Rate
- 1990
Drowning Death Rate
- 2000
Drowning Death Rate
- 2014
154
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
1
2
3
4
5
6
7
8
9
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 20. Number of Deaths from Drownings per 100,000 Population, by Sex
Collier County, 2005 -2014
0
1
2
3
4
5
6
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 21. Number of Deaths from Drownings per 100,000 Population, by Race,
Collier County, 2005015–2014
155
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
1
2
3
4
5
6
7
8
9
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic
Linear Trend
Collier County
Non-Hispanic
Linear Trend
Figure 22. Number of Deaths from Drownings per 100,000 Population, by Ethnicity
Collier County, 2005–2014
156
Falls
From 2005 to 2014, the mortality rate due to falls increased in Collier County by 49 percent and
in Florida by 38.6 percent (Figure 23). As discussed the section on injury mortality, the mortality
rate from falls increased exponentially in the 75 years of age and over group. At the same time,
this at-risk cohort is growing faster than the younger population due to the aging of the baby
boomer generation. This can pose a number of challenges for Collier County.
Figure 24 gives the number of deaths for select age groups from falls per 100,000 population in
Collier County for 1990, 2000 and 2014. The mortality rate from falls was relatively low or non-
existent in age groups prior to 64 years of age; however, it experienced an exponential increase
beginning at ages 75 and over, most evidently in 2014.
The mortality rates from falls in the county are increasing steadily and in parallel for both males
(an increase of 49.5 percent) and females (an increase of 51.7 percent) for the period of 2005 to
2014 (Figure 25). In Florida, the death rates from falls are also increasing at a steady parallel
pace for both males (an increase of 30 percent) and females (an increase of 48.1 percent). As
with all of the select causes of mortality from injuries analyzed in this assessment, males
inevitably experience higher death rates than females.
Among races in Collier County, the white mortality rate for falls has increased by 48 percent
between 2005 and 2014, mainly due to the exponential increase in the number of deaths 75
years and older (Figure 26). Insufficient data exist in Collier County to analyze the black
mortality rate. In Florida, the white mortality increased by 39.7 percent, while the black mortality
rate for falls exhibited a stable trend.
In Collier County, the Hispanic mortality rate from falls has been steadily increasing since 2005
at a pace parallel to the non-Hispanic mortality rate (Figure 27). The Hispanic mortality rate from
falls experienced dramatic fluctuations over the period of 2005 to 2014. In Florida, the Hispanic
mortality rate for falls has been constant since 2005, while the non-Hispanic rate has been
increasing steadily over the 10-year period.
157
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
100
200
300
400
500
600
25-34 35-44 45-54 55-64 65-74 75-84 85+Rate per 100,000Age Group
Figure 24. Number of Deaths from Falls per 100,000 Population, by Age,
Collier County,1990, 2000 and 2014
Fall Death
Rates - 1990
Fall Death
Rates - 2000
Fall Death
Rates - 2014
0
2
4
6
8
10
12
14
16
18
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Florida
Collier County
Linear Trend
Florida Linear
Trend
Figure 23. Number of Deaths from Falls per 100,000 Population,
Collier County and Florida, 2005–2014
158
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
2
4
6
8
10
12
14
16
18
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 25. Number of Deaths from Falls per 100,000 Population, by Sex,
Collier County, 2005–2014
0
5
10
15
20
25
30
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 26. Number of Deaths from Falls per 100,000 Population, by Race
Collier County, 2005–2014
159
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic
Linear Trend
Collier County
Non-Hispanic
Linear Trend
Figure 27. Number of Deaths from Falls per 100,000 Population, by Ethnicity,
Collier County, 2005–2014
160
Homicides
Figure 28 shows deaths from homicide per 100,000 population for Collier County and Florida for
the period 2005 to 2014. Mortality rates from homicide in Collier County fluctuated significantly
throughout the 10-year period, but the trend remained constant. In Florida, the mortality rates
from homicides exhibited a stable trend from 2005 to 2014.
In Collier County, both genders displayed random variation due to small numbers of deaths due
to homicide in select years. The male mortality rate from homicide increased by 34.1 percent
over the 20 year interval, whereas the female rate declined by 55.6 percent (Figure 29). In the
state of Florida, the mortality rate for homicides for both males and females showed stable and
constant trends with males having significantly higher rates than females.
The mortality rates from homicide for Collier County per 100,000 population by race from 2005
to 2014 is displayed in figure 30. In Collier County, the black homicide mortality rate has been
trending upwards, while the white homicide mortality rate has remained constant. Both the white
and black homicide rates in Florida have been stable; however, black mortality rates were
significantly higher than white mortality rates over the 10 year period.
By ethnicity, the mortality rates due to homicide among non-Hispanic in Collier County have
been trending upward since 2005, while Hispanic mortality rates have been trending downward
(Figure 31). Throughout the state, non-Hispanic homicide mortality rates exceeded the Hispanic
homicide mortality rates between 2005 and 2014. The Hispanic homicide mortality rates in
Florida are decreased by 10 percent, while non-Hispanic homicide rates showed a constant
trend.
Figure 32 gives the age-specific mortality rates from homicide in Collier County for the years
1990, 2000 and 2014. It is evident from the graph that between the age groups of 15 to 84 years
there has been a downward trend in mortality between 1990 and 2014. The age groups of
primary concern in Collier County as of 2014 were 25 to 54 years of age.
161
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
1
2
3
4
5
6
7
8
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Florida
Collier County
Linear Trend
Florida Linear
Trend
Figure 28. Number of Deaths from Homicide per 100,000 Population,
Collier County and Florida, 2005–2014
0
1
2
3
4
5
6
7
8
9
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Male
Collier County
Female
Collier County
Male Linear
Trend
Collier County
Female Linear
Trend
Figure 29. Number of Deaths from Homicide per 100,000 Population, by Sex,
Collier County, 2005–2014
162
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
5
10
15
20
25
30
35
40
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
White
Collier County
Black
Collier County
White Linear
Trend
Collier County
Black Linear
Trend
Figure 30. Number of Deaths from Homicide per 100,000 Population, by Race
Collier County, 2005–2014
0
2
4
6
8
10
12
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier County
Hispanic
Collier County
Non-Hispanic
Collier County
Hispanic Linear
Trend
Collier County
Non-Hispanic
Linear Trend
Figure 31. Number of Deaths from Homicide per 100,000 Population, by Ethnicity
Collier County, 2005–2014
163
Data Source: Bureau of Vital Statistics, Florida Department of Health, U.S. Census Bureau
0
10
20
30
40
50
60
15-19 20-24 25-34 35-44 45-54 55-64 65-74 75-84Rate per 100,000Age Group
Figure 32. Number of Deaths from Homicide per 100,000 Population, by Age,
Collier County, 1990, 2000 and 2014
Homicide
Rate-1990
Homicide
Rate-2000
Homicide
Rate-2014
164
Access to Health Services
Access to health care and health services implies the timely availability and use of personal
health services in order to achieve the best health status outcomes. In order for the population
of a community to gain access to health services the following are requisites:
Obtain entry into the healthcare system.
Locate and access a location where the needed healthcare services are provided.
Access a health care provider with whom the patient can communicate with confidence.
Lack of access to health care or failure to access health care and health care services has a
direct impact and effect on the health status of a community, county and state.
The overall level of physical, social and mental health status is impacted by the degree of
access to health services. Access to healthcare impacts disease prevention through early
detection and treatment of health conditions. Access to health services also increases the
quality of life by reducing preventable mortality (Years of Potential Life Lost) while
simultaneously increasing the number of years one can expect to live beginning at birth (life
expectancy).
Health insurance coverage assists patients in gaining access to the healthcare system. Lack of
health insurance is very highly correlated with failure to receive medical care, with early and
premature death and with overall poor health status. As the United States does not have a
universal healthcare model, private health insurance coverage is an integral mainstay for
access to healthcare for the core working population 18–64 years of age and vital to the
personal well-being and health of individuals in Collier County and Florida.
In-depth research has shown that when children are covered by health insurance they receive
more timely diagnoses of severe health conditions and experience fewer preventable
hospitalizations than children without health insurance. Further research has uncovered that
among adults, harmful health effects are correlated with being uninsured, particularly related to
chronic diseases and serious injury or trauma.
165
Table 1 shows the detrimental effects of the lack of insurance for adults with select chronic
disease and acute conditions and chronic diseases. It is evident for certain conditions such as
stroke, congestive heart failure, heart attack and motor vehicle crashes that the risk of a fatal
outcome increases notably for those without health insurance coverage.
The trend in the U.S. over the past two decades had been a decline in health insurance
coverage while healthcare costs and health insurance premiums have risen continuously.
A new analysis of the Affordable Care Act’s health insurance marketplace costs finds that
nationwide, marketplace premiums did not increase at all from 2014 to 2015, although some
states experienced substantial increases in average premium while in others the premiums
declined.
This average zero percent change in average premiums is unprecedented when compared with
historic trends. Prior to the implementation of the Affordable Care Act, from 2008 to 2010,
health insurance premiums grew an average of 10 percent or more per year in state insurance
markets. This is a significantly higher rate of increase than the average increase in worker
earnings during the same time period.
Uninsured persons frequently delay or cancel visits to providers, defer obtaining prescription
medications and other treatments, even with serious disease and life-threatening conditions.
Uninsured children are 20 to 30 percent more likely to lack their immunizations, prescription
medications, asthma care and basic dental care. Uninsured adults with chronic conditions are
two to four times more likely than insured adults to have not received medical attention in the
prior year. Uninsured adults are also more likely to be diagnosed with later-stage cancer
compared to the insured as a consequence of the lack of insurance resulting in the unavailability
of cancer screening. Uninsured adults are 25 percent more likely to die prematurely than
insured adults from all causes, and with conditions such as heart disease, diabetes or cancer,
their risk of premature mortality can be 40 to 50 percent higher than the insured population
thereby increasing years of potential life lost and lowering life expectancy for this growing
segment of the population.
166
Table 1: Detrimental Effects of Lack of Health Insurance for Adults with Select Chronic Conditions and Disease
Condition Effects
Heart Attack The uninsured are more likely than the insured to have a fatal outcome.
Stroke The uninsured are more likely than the insured to result in extremely poor outcomes,
including neurological impairment, intracerebral hemorrhage and death.
Cancer
The uninsured are more likely than the insured to be diagnosed at an advanced stage of
cancer, especially for those sites with available effective treatments and available early
screening detection (breast or colorectal cancer) or by clinical assessment of symptoms
(melanoma, bladder cancer).
Diabetes The uninsured adults have significantly worse glycemic control than the insured
Congestive Heart Failure The uninsured are at greater risk of death than the insured.
Hypertension The uninsured are less likely than the insured to be aware of hypertension and, if
hypertensive, more likely to have inadequate blood pressure control.
Hospital Inpatients with
Serious Acute Conditions
The uninsured are at greater risk than the insured of higher mortality in hos pitals and for
at least 2 years after following admission.
Serious Injury or Trauma
After an unintentional injury, the uninsured are less likely than the insured to fully
recover and are more likely to report subsequent declines in health status, the
uninsured in severe automobile accidents have a substantially higher mortality rate than
those insured.
Health Insurance Coverage in Collier County
In Collier County, as throughout the State of Florida and the United States, rates of health
insurance coverage had been declining during the past two decades. This movement downward
in insurance coverage was exasperated by the recession beginning in 2007 which pushed the
uninsured population to historical heights as unemployment spiraled upwards. Recent changes
167
beginning during 2013 involving the enactment of the new national healthcare law appears to
have redirected and reversed the direction of inertia that had been trending over several
decades. The year 2013 serves as the benchmark year for uninsured rates that existed prior to
the law’s enactment. Collectively throughout the country, 47 of the 50 states experienced a
decline in their uninsured rates since the legislation became law. Florida’s uninsured rate
declined from 21.3 percent in 2010 to 16.6 percent in 2014.
Table 2 and Figure 1 show the percentage of the population in Collier County uninsured for
2010 and 2014. In 2010, 23.2 percent of the total resident population of Collier County was
uninsured, by 2014 this number declined significantly by 4.5 percentage points to 18.7 percent.
By age group, the largest decrease in the uninsured rate in Collier County was for those under
18 years of age-from 18.5 percent in 2010 to 12 percent in 2014.-a decline of 6.5 points. The
population 18 to 64 years of age experienced a decrease of 5.2 percentage points, from 35.9
percent in 2010 to 30.7 percent uninsured in 2014. The uninsured population 65 years and older
was the only age group to experience an increase, from 0.8 percent in 2010 to 1.4 percent in
2014.
Table 2: Percentage of the Population Uninsured by Age, Collier County, 2010 and 2014
2010 2014
Total All Ages 23.2% 18.7%
Under 18 Years of Age 18.5% 12.0%
18 - 64 Years of Age 35.9% 30.7%
65 Years and Older 0.8% 1.4%
Data Source: American Community Survey/US Census Bureau
168
Table 3 and Figure 2 show the percentage distribution of the uninsured population in Collier
County by sex for 2010 and 2014. Both males and females experienced a greater than 4
percentage point reduction on their uninsured rates. Table 4 and Figure 3 describe the
percentage distribution of the uninsured population of Collier County by race and ethnicity.
Between 2010 and 2014 the percentage of the uninsured white population declined by 5.2
percentage points, from 20.1 percent to 14.9 percent, respectively. (This is a 26 percent relative
decline in the uninsured rate for the 2010-2014 time period). During the same time interval, the
uninsured percentage of the black population in Collier County increased by four tenths of a
percentage point - +0.4 percent. While the root cause of this minute change is unknown at this
time, it may be due to the random variation of small numbers which can occur just due to
chance. (In 2014, the resident black population of Collier County accounted for approximately 7
percent of the total county population, or about 24,000).
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
Total All Ages Under 18 Years of
Age
18 - 64 Years of Age 65 Years and OlderPercentage
Age
2010
2014
Figure 1. Percentage of the Population Uninsured by Age,
Collier County, 2010 and 2014
169
Table 3: Percentage of the Population Uninsured by Sex, Collier County, 2010 and 2014
2010 2014
Males 25.4% 20.5%
Females 21.2% 17.1%
Data Source: American Community Survey/US Census Bureau
25.4%
21.2%20.5%
17.1%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
Males FemalesPercentage
Sex
2010
2014
Figure 2. Percentage of the Population Uninsured by Sex,
Collier County, 2010 and 2014
170
Table 4. Percentage of the Population Uninsured by Race and Ethnicity, Collier County, 2010 and 2014
Race and Ethnicity 2010 2014
White 20.1% 14.9%
Black 29.1% 29.5%
Hispanic 48.2% 39.2%
Data Source: American Community Survey/US Census Bureau
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
White Black HispanicPercentage
Race and Ethnicity
2010
2014
Figure 3. Percentage of the Population Uninsured by Race and Ethnicity,
Collier County, 2010 and 2014
171
At the time of this writing, Hispanics comprised approximately 1 out of every 3 Collier County
residents. During the period 2010 to 2014 the percentage of the uninsured Hispanic population
in Collier County declined by 9 percentage points, from 48.2 percent in 2010 to 39.2 percent in
2014.
Table 5 and Figure 4 show the percentage of the population uninsured by educational
attainment level in Collier County for 2010 and 2014. A consistent pattern exists between the
level of educational achievement and the rate of uninsured. The higher the educational
attainment the more likely one can afford health insurance. Between 2010 and 2014 the
percentage of uninsured high school graduates in Collier County declined by 6.2 percentage
points, from 28.8 percent to 22.6 percent, respectively.
The percentage of uninsured with some college or an associate’s degree decreased from 16.0
percent in 2010 to 11.7 percent in 2014, an overall decline of 4.3 percentage points. Those
individuals with a bachelor’s degree or higher had the largest relative percentage decrease
among the uninsured, from 9.3 percent in 2010 to 6.0 percent in 2014. This translates into a
relative decline of 36 percent in the uninsured rate. Figure 4 graphically depicts this direct
consistent correlation between educational attainment and health insurance coverage in a very
normalized distribution.
Table 6 along with Figure 5 illustrates the relationship between income level and the proportion
of the population uninsured in Collier County for 2010 and 2014. The association of the
reduction of the percentage of the uninsured in every income level between 2010 and 2014 is
very evident. Figure 5 is a textbook graphic correlation between income categories and access
to or the ability to acquire health insurance. While the percentage of the uninsured decreased
for every income level between 2010 and 2014, the most significant changes in the rate
occurred among those earning $25,000 to $49,999 and those earning $75,000 to $99,999, with
reductions of 7.0 and 6.1 percentage points, respectively.
172
Table 5. Percentage of the Population Uninsured by Education, Collier County, 201 0 and 2014
2010 2014
All Levels 22.0% 18.7%
Less than High School 48.1% 52.6%
High School Graduate 28.8% 22.6%
Some College or
Associates Degree 16.0% 11.7%
Bachelor's Degree or
Higher 9.3% 6.0%
Data Source: American Community Survey/US Census Bureau
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
All Levels Less than High
School
High School
Graduate
Some College or
Associates
Degree
Bachelor's
Degree or HigherPercentage
Education
2009
2014
Figure 4. Percentage of the Population Uninsured by Education,
Collier County, 2010 and 2014
173
Table 6. Percentage of the Population Uninsured by Income, Collier County, 2010 and 2014
2010 2014
All Incomes 23.3% 18.4%
Under $25,000 33.7% 31.8%
25,000 to 49,999 31.6% 24.6%
50,000 to 74,999 21.5% 20.3%
75,000-99,999 16.8% 10.7%
100,000 and Over 9.6% 8.3%
Data Source: US Census Bureau. SAHIE
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%All IncomesUnder $25,00025,000 to 49,99950,000 to 74,99975,000-99,999100,000 and OverPercentageIncome
2010
2014
Figure 5. Percentage of the Population Uninsured by Income,
Collier County, 2010 and 2014
174
Tables 7, 8 and 9 gives the number of hospital beds available in Collier County and Florida in
2005 and 2014, with rates per 100,000 population. Between 2005 and 2014, the rate of total
hospital beds in Collier County increased by 31 percent while in Florida the rate remained flat.
During the same period the rate for acute-case beds in Collier County increased by 37 percent
while in Florida the rate decreased by 3 percent. These differences in rates of growth in bed
availability in Collier County and Florida is comparable to the trend observed in past analyses
between 2003 and 2011. In both Collier County and Florida the rates for specialty beds
increased between 2005 and 2014, by seven percent and five percent, respectively.
Table 7. Total Hospital Beds with Rates per 100,000, Collier County and Florida, 2005 - 2014
2005 2014
Count Rate Count Rate
Collier County 673 219.90 977 287.2
Florida 57,724 319.1 62,021 317.3
Data Source: Agency for Health Care Administration
Table 8. Total Acute Care Beds with Rates per 100,000, Collier County and Florida, 2005 - 2014
2005 2014
Count Rate Count Rate
Collier County 539 176.14 818 240.5
Florida 48,021 268.6 50,887 260.3
Data Source: Agency for Health Care Administration
175
Table 9. Total Specialty Beds with Rates per 100,000, Collier County and Florida, 2005 - 2014
2005 2014
Count Rate Count Rate
Collier County 134 43.8 159 46.7
Florida 9,703 54.3 11,134 57.0
Data Source: Agency for Health Care Administration
The total number of licensed physicians per 100.000 population increased by 33 percent in
Collier County between 2005 and 2014 (Table 10). In Florida, the rate of licensed physicians
grew by 29 percent during the same period.
While total population growth in Collier County has been slowing dramatically in recent years-
0.9 percent annually between 2013 and 2014 compared with 3.7 percent annual growth
between 2003 and 2004, the baby boomer cohort has been accelerating in growth as their
generation continues to age. Between 1995 and 2014, the population 75 years of age and over
in Collier County grew by 119 percent. During the same time period the county’s population 65
years of age and over grew by 82 percent. These exponential increases and the demographic
dynamics of the older population within Collier County is having a powerful influence on the
increments of healthcare resources within the community.
Table 10. Total Licensed Physicians with Rates per 100,000, Collier County and Florida, 2005–2014
2005 2014
Count Rate Count Rate
Collier County 605 204.3 915 271.2
Florida 37,267 213.2 53,529 275.7.0
Data Source: Florida CHARTS
176
Health Behaviors and Health Status
One of the correlates of higher levels of life expectancy and quality of life has historically been
the level of educational attainment due to its direct overall statistical association with income
level. These statistical correlations have held up scientifically since public health epidemiology
and economic data have been analyzed nationally, regionally and locally. As can been seen in
this chapter on healthy behaviors and health status, healthy habits, whether diet related or
tobacco or alcohol use oriented, are highly associated with the level of education and level of
income. Gender also plays a significant role. Females are more likely to choose a healthier
lifestyle and its concomitant habits than males. This fact is one of the primary influences on the
higher life expectancy of females compared to that of males. A married individual of either sex is
less likely to engage in unhealthy and riskier habits than an unmarried person.
It is estimated in the United States that the two most prevalent unhealthy behaviors or lifestyle
related habits–tobacco use and overweight and obesity–account for almost 35 percent (more
than one third) of all preventable and premature deaths annually. This holds true for Collier
County and Florida as well and is explored more in depth in the mortality chapter.
Although data for Collier County on these health behaviors in this section are available only
from the Florida Department of Health’s Behavioral Risk Factor Surveillance System (BRFSS)
randomly selected scientific sample survey, these results are statistically valid and are
representative of the community and population of Collier County. These are the indicators that
guide the County Health Department’s assessment of progress towards healthy behaviors
within the community.
177
Important Technical Note
Since the 2013 Florida county level BRFSS utilizes the new Center for Disease Control survey
methodology called raking, which allows for the inclusion of additional sociodemographic
variables as well as the incorporation of the type of telephone source (landline or cellular
telephone) into the statistical weighting process. The comparison of these latest 2013 county
level survey data to any of the previous county-level BRFSS surveys (2002–2010) is not
recommended. For this reason this 2016 Community Health Assessment Health Behaviors and
Health Status chapter is limited to data for the year 2013. The year 2013 will serve as the
beginning for a new data base series for trends in health behaviors and health status for Collier
County. Future trends and analyses over time will begin with this year.
178
Obesity and Overweight
In 2013, 20.8 percent of Collier County adults indicated they were obese. This was almost 6
percentage points lower than the proportion in Florida (Figure 1). Both the county and the state
have seen their percentage of obese adults increase since 2002. This trend mirrors the national
situation in most states.
When obesity is analyzed by gender, males are much more likely to be obese than females-
both in Collier County and throughout the state. In Collier County 23.1 percent of males were
obese in 2013. This was 4.4 percent points lower than the male obesity rate for Florida. Less
than 1 in 5 women in Collier County were obese, while in Florida the ratio was more than one in
four (Figures 2 and 3).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
20.8%
26.4%
0%
5%
10%
15%
20%
25%
30%
Collier FloridaPercentageFigure 1. Percent of Adults Who Are Obese, Collier County and Florida, 2013
179
Data Source: Behavioral Risk Factor Surveillance System, 2013.
23.1%
18.4%
0%
5%
10%
15%
20%
25%
Male FemalePercentageFigure 2. Percent of Adults Who Are Obese, by Sex, Collier County, 2013
27.5%
25.3%
0%
5%
10%
15%
20%
25%
30%
Male FemalePercentageFigure 3. Percent of Adults Who Are Obese, by Sex, Florida, 2013
180
Hispanics in Collier County were more than twice as likely to be obese than non-Hispanics, 34.8
percent compared with 16.0 percent, respectively (Figure 4). In Florida, the opposite prevailed,
29.7 percent of non-Hispanics were obese compared with 26.4 percent of Hispanics (Figure 5).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
34.8%
16.0%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Hispanic Non-HispanicPercentageFigure 4. Percent of Adults Who Are Obese, by Ethnicity, Collier County, 2013
26.4%
29.7%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Hispanic Non-HispanicPercentageFigure 5. Percent of Adults Who Are Obese, by Ethnicity, Florida, 2013
181
Adults in Collier County and Florida are less likely to be obese if they have a four year college
degree or beyond, 15.3 percent and 24.5 percent, respectively compared with only a high
school degree or some college, 27.6 percent and 28.4 percent, respectively (Figures 6 and 7).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
27.6%
15.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 6. Percent of Adults Who Are Obese, by Educational Level, Collier County, 2013
29.4%
28.4%
24.5%
22.0%
23.0%
24.0%
25.0%
26.0%
27.0%
28.0%
29.0%
30.0%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 7. Percent of Adults Who Are Obese, by Educational Level, Florida, 2013
182
The level of obesity and overweight levels in a population is predominately a result of
consuming too many calories while participating in too little physical activity. An increase in the
prevalence of obesity and overweight is associated with a higher incidence of numerous chronic
diseases including stroke, hypertension, cancer, cardiovascular disease and diabetes. This
same type of statistical correlation exists between the level of physical activity and the
prevalence of chronic health conditions. Premature mortality as measured by years of potential
life lost is also strongly statistically correlated with decreased physical activity, obesity and
overweight prevalence.
It is estimated that obesity and overweight in the general population accounts for approximately
17 percent of all actual causes of death. This amounts to about 1 out of every 6 deaths annually
in Collier County. The most recent prevalence data from CDC for 2011-2012 indicate that
approximately 35 percent of U.S. adults were obese. For the youth ages 2 to 19 years the
obesity rate was 17 percent. These data also imply that adults aged sixty years and older were
more likely to be obese than comparable younger age groups.
As is the case with numerous health conditions and behaviors, the income level of a population
is statistically correlated with the prevalence of obesity. Figures 8 and 9 show the prevalence of
obesity by annual income category for both Collier County and Florida in 2013. As a rule, the
pattern is consistent: the lower the income, the higher the percentage of adult population who
are obese. The only exception to this was in Collier County for persons with an annual income
of $25,000 to $49,999, where that income category is a fraction higher in the obesity rate than
those with the lowest income.
183
Data Source: Behavioral Risk Factor Surveillance System, 2013.
27.8%28.1%
17.5%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 8. Percent of Adults Who Are Obese, by Annual Income, Collier, 2013
29.9%
27.7%
24.6%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 9. Percent of Adults Who Are Obese, by Annual Income, Florida, 2013
184
In both Collier County and Florida the prevalence rate of obesity is greatest in the 45–64 years
age group (Figures 10 and 11).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
24.2%
30.3%
24.8%
0%
5%
10%
15%
20%
25%
30%
35%
18-44 45-64 65 & OlderPercentageFigure 11. Percent of Adults Who Are Obese, by Age Group, Florida, 2013
19.5%
21.7%21.4%
0%
5%
10%
15%
20%
25%
30%
35%
18-44 45-64 65 & OlderPercentageFigure 10. Percent of Adults Who Are Obese,by Age Group, Collier, 2013
185
Being married appears to increase the probability of being obese in Collier County as well as in
Florida (Figures 12 and 13).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
21.7%
19.8%
0%
5%
10%
15%
20%
25%
30%
Married/ Couple Not Married/ CouplePercentageFigure 12. Percent of Adults Who Are Obese, by Marital Status, Collier County, 2013
27.9%
24.7%
0%
5%
10%
15%
20%
25%
30%
Married/ Couple Not Married/ CouplePercentageFigure 13. Percent of Adults Who Are Obese, by Marital Status, Florida, 2013
186
Overall Collier County residents are less likely to be overweight than their Florida counterparts
(Figure 14).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
33.0%
36.4%
0%
10%
20%
30%
40%
Collier FloridaPercentageFigure 14. Percent of Adults Who Are Overweight, Collier County and Florida, 2013
187
Males are consistently more likely to be overweight than females in Collier County and
throughout the state (Figures 15 and 16).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
42.9%
30.0%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Male FemalePercentageFigure 16. Percent of Adults Who Are Overweight, by Sex, Florida, 2013
44.8%
20.7%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Male FemalePercentageFigure 15. Percent of Adults Who Are Overweight, by Sex, Collier County, 2013
188
In Collier County, Hispanics are less likely to be overweight than Non-Hispanics while in the
state of Florida the opposite is true (Figures 17 and 18).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
23.8%
36.3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Hispanic Non-HispanicPercentageFigure 17. Percent of Adults Who Are Overweight, by Ethnicity, Collier County, 2013
38.6%
36.4%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Hispanic Non-HispanicPercentageFigure 18. Percent of Adults Who Are Overweight, by Ethnicity, Florida, 2013
189
The correlation between educational attainment and overweight prevalence appears to persist
at the county and state level although not as strong an association as that found with obesity
prevalence (Figure 19 and 20).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
29.7%
35.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 19. Percent of Adults Who Are Overweight, by Educational Level,
Collier County, 2013
Data not
Available
38.4%
35.4%36.5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 20. Percent of Adults Who Are Overweight, by Educational Level,
Florida, 2013
190
When income is analyzed in relation to overweight prevalence, interesting trends are
uncovered. While in Florida the higher the income level the slightly greater the percentage of the
adult population overweight, in Collier County no definitive pattern exists although adults making
$50,000 or more annually have the highest overweight rate 36.6 percent (Figures 21 and 22).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
33.1%
24.2%
36.6%
0%
5%
10%
15%
20%
25%
30%
35%
40%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 21. Percent of Adults Who Are Overweight, by Annual Income, Collier, 2013
34.8%
37.1%37.8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 22. Percent of Adults Who Are Overweight, by Annual Income, Florida, 2013
191
By age, older Collier County and Florida residents tend to have a higher overweight prevalence
compared to younger aged residents. In Collier County, adults with the lowest overweight
prevalence are found in the 45–64 year age group (Figures 23 and 24).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
32.1%
28.4%
38.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
18-44 45-64 65 & OlderPercentageFigure 23. Percent of Adults Who Are Overweight, by Age Group, Collier, 2013
31.5%
39.4%40.6%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
18-44 45-64 65 & OlderPercentageFigure 24. Percent of Adults Who Are Overweight, by Age Group, Florida, 2013
192
In both Collier County and the state of Florida, married individuals are more likely to be
overweight than those not married (Figures 25 and 26).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
37.5%
26.0%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Married/ Couple Not Married/ CouplePercentageFigure 25. Percent of Adults Who Are Overweight, by Marital Status, Collier County, 2013
39.5%
32.9%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Married/ Couple Not Married/ CouplePercentageFigure 26. Percent of Adults Who Are Overweight, by Marital Status, Florida, 2013
193
Tobacco Use
The percentage of the adult population who are current smokers in a community measures the
extent of the health risk within that population related to tobacco use and its detrimental effects.
The relationship between the use of tobacco and unfavorable health outcomes and conditions is
well documented and scientifically well proven. Cigarette smoking is the leading cause of
preventable mortality in the United States and Florida. In Collier County, alone, annually at
least, 18 percent of all deaths are associated with cigarette smoking. This amounts to almost
one out of every five deaths in Collier County. Smoking has been scientifically associated as a
direct cause of a myriad of illnesses including numerous cancers, heart diseases, strokes,
respiratory diseases and unfavorable maternal outcomes.
Smoking cessation initiatives and programs are cost-effective public health strategies since
discontinuing tobacco use leads to improved and measurable health benefits at any age and
ultimately results in an increase in life expectancy.
In 2013, the percent of adults who were currently smoking in Collier County was significantly
lower than the proportion throughout the state of Florida, 13.9 percent compared with 16.8
percent, respectively (Figure 27). By gender, the percentage of adult females currently smoking
in Florida was 5.7 percentage points greater than in Collier County, while the percentage of
male smokers was almost identical in Collier County and Florida, 19.4 percent and 19.5 percent,
respectively (Figures 28 and 29).
194
Data Source: Behavioral Risk Factor Surveillance System, 2013.
13.9%
16.8%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Collier FloridaPercentageFigure 27. Percent of Adults Who are Currently Smokers, Collier County and Florida, 2013
19.4%
8.7%
0%
5%
10%
15%
20%
25%
Male FemalePercentageFigure 28. Percent of Adults Who are Currently Smokers, by Sex, Collier County, 2013
195
Data Source: Behavioral Risk Factor Surveillance System, 2013.
In both Collier County and Florida an inverse association exists between smoking prevalence
and income level, lower income levels are correlated with higher smoking rates (Figures 30 and
31). This same relationship can be seen between educational attainment level and the percent
of adult smokers (Figures 32 and 33). Both income levels and educational attainment predict
cigarette smoking prevalence levels within a population or a community.
19.5%
14.4%
0%
5%
10%
15%
20%
25%
Male FemalePercentageFigure 29. Percent of Adults Who are Currently Smokers, by Sex, Florida, 2013
196
Data Source: Behavioral Risk Factor Surveillance System, 2013.
26.4%
18.1%
7.5%
0%
5%
10%
15%
20%
25%
30%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 30. Percent of Adults Who are Currently Smokers, by Annual Income, Collier County, 2013
22.3%
17.7%
11.8%
0%
5%
10%
15%
20%
25%
30%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 31. Percent of Adults Who are Currently Smokers, by Annual Income, Florida, 2013
197
Data Source: Behavioral Risk Factor Surveillance System, 2013.
32.9%
15.3%
7.6%
0%
5%
10%
15%
20%
25%
30%
35%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 32. Percent of Adults Who are Currently Smokers, by Educational Level, Collier County, 2013
24.8%
19.8%
13.1%
0%
5%
10%
15%
20%
25%
30%
35%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 33. Percent of Adults Who are Currently Smokers, by Educational Level, Florida, 2013
198
By ethnicity, in Collier County, Hispanics are almost twice as likely to be current smokers
compared with non-Hispanics. In the state of Florida the reverse association is found (Figures
34 and 35).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
21.7%
11.4%
0%
5%
10%
15%
20%
25%
Hispanic Non-HispanicPercentageFigure 34. Percent of Adults Who are Currently Smokers, by Ethnicity, Collier County, 2013
13.9%
16.5%
0%
5%
10%
15%
20%
25%
Hispanic Non-HispanicPercentageFigure 35. Percent of Adults Who are Currently Smokers, by Ethnicity, Florida, 2013
199
Married couples have a significantly lower smoking rate than non-married couples in both Collier
County and the state. In 2013, only 7.2 percent of married couples in Collier County were
current smokers compared with a 23.9 percent prevalence among non-married couples, a
difference of 16.7 percentage points. In Florida, 13.6 percent of married couples were current
smokers compared with 20.8 among non-married couples (Figures 36 and 37). This protective
health status effect of married individuals has been studied by epidemiologists for several
decades.
Data Source: Behavioral Risk Factor Surveillance System, 2013.
7.2%
23.9%
0%
5%
10%
15%
20%
25%
30%
Married/ Couple Not Married/ CouplePercentageFigure 36. Percent of Adults Who are Currently Smokers, by Marital Status, Collier County, 2013
200
Data Source: Behavioral Risk Factor Surveillance System, 2013.
Younger ages 18–44 years, and mid-life ages 45–64 years have a significantly higher smoking
prevalence than those 65 years of age and older (Figures 38 and 39). The percentage of the
population that are former smokers is consistently gradually increasing over time as the cohorts
of the 18–44 and the 45–64 year age groups cease the habit cumulatively (Figure 40).
In Collier County almost 45 percent of males and 28 percent of females are former smokers
while in Florida the corresponding ratios are 31.6 percent and 24.9 percent, respectively
(Figures 41 and 42).
13.6%
20.8%
0%
5%
10%
15%
20%
25%
30%
Married/ Couple Not Married/ CouplePercentageFigure 37. Percent of Adults Who are Currently Smokers, by Marital Status, Florida, 2013
201
Data Source: Behavioral Risk Factor Surveillance System, 2013.
17.9%
22.4%
2.4%
0%
5%
10%
15%
20%
25%
18-44 45-64 65 & OlderPercentageFigure 38. Percent of Adults Who are Currently Smokers, by Age Group, Collier County, 2013
19.2%19.8%
8.7%
0%
5%
10%
15%
20%
25%
18-44 45-64 65 & OlderPercentageFgure 39. Percent of Adults Who are Currently Smokers, by Age Group, Florida, 2013
202
Data Source: Behavioral Risk Factor Surveillance System, 2013.
36.3%
28.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Collier FloridaPercentageFigure 40. Percent of Adults Who are Former Smokers, Collier County and Florida, 2013
44.8%
28.2%
0%
10%
20%
30%
40%
50%
Male FemalePercentageFigure 41. Percent of Adults Who are Former Smokers, by Sex, Collier County, 2013
203
Data Source: Behavioral Risk Factor Surveillance System, 2013.
The percentage of former smokers in Collier County and in the United States is strongly
correlated with income level and educational attainment, the greater the income and the higher
the level of education, the more likely the individual is to become a former smoker (Figures 43,
44, 45 and 46). The only deviation from this association is seen in Florida in 2013 where there
are a slightly larger proportion of former smokers (31.9 percent) earning $25,000 to $49,999
than those earning $50,000 or more (30.0 percent).
31.6%
24.9%
0%
10%
20%
30%
40%
50%
Male FemalePercentageFigure 42. Percent of Adults Who are Former Smokers, by Sex, Florida, 2013
204
Data Source: Behavioral Risk Factor Surveillance System, 2013.
23.9%
31.9%
30.0%
0%
10%
20%
30%
40%
50%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 44. Percent of Adults Who are Former Smokers, by Annual Income, Florida, 2013
22.9%
30.7%
45.0%
0%
10%
20%
30%
40%
50%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 43. Percent of Adults Who are Former Smokers, by Annual Income, Collier County, 2013
205
Data Source: Behavioral Risk Factor Surveillance System, 2013.
14.1%
38.3%
42.2%
0%
10%
20%
30%
40%
50%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 45. Percent of Adults Who are Former Smokers, by Educational Level, Collier County, 2013
25.7%
27.7%29.1%
0%
10%
20%
30%
40%
50%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 46. Percent of Adults Who are Former Smokers, by Educational Level, Florida, 2013
206
Consistent with the data covering current smokers, married individuals in Collier County and in
Florida are more likely to be former smokers. This difference in this health behavior gap
between married and not married individuals is approximately twice that in Collier County than
throughout the state (Figures 47 and 48).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
43.0%
27.4%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Married/ Couple Not Married/ CouplePercentageFigure 47. Percent of Adults Who are Former Smokers, by Marital Status, Collier County, 2013
32.0%
23.7%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Married/ Couple Not Married/ CouplePercentageFigure 48. Percent of Adults Who are Former Smokers, by Marital Status, Florida, 2013
207
In Collier County the percent of former smokers in all three age groups is substantially greater
than that of the state of Florida. This is likely due to the greater level of affluence and education
per capita within the community, which results in a higher awareness of the benefits of healthier
lifestyles (Figures 49 and 50).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
19.1%
35.7%
52.6%
0%
10%
20%
30%
40%
50%
60%
18-44 45-64 65 & OlderPercentageFigure 49. Percent of Adults Who are Former Smokers, by Age Group, Collier County, 2013
15.6%
30.3%
47.4%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
18-44 45-64 65 & OlderPercentageFigure 50. Percent of Adults Who are Former Smokers, by Age Group, Florida, 2013
208
Figure 51 shows the percent of adults who have never smoked in Collier County and Florida.
Collier County residents are less likely to have never smoked than the average Floridian.
Data Source: Behavioral Risk Factor Surveillance System, 2013.
Females in Collier County are much more likely to have never smoked (63.1 percent) than
males (35.8) percent. This same pattern exists for the state of Florida although the variation is
narrower between males (48.9 percent) and females (60.7 percent (Figures 52 and 53).
49.9%
55.0%
0%
10%
20%
30%
40%
50%
60%
Collier FloridaPercentageFigure 51. Percent of Adults Who Have Never Smoked, Collier County and Florida, 2013
209
Data Source: Behavioral Risk Factor Surveillance System, 2013.
35.8%
63.1%
0%
10%
20%
30%
40%
50%
60%
70%
Male FemalePercentageFigure 52. Percent of Adults Who Have Never Smoked, by Sex, Collier County, 2013
48.9%
60.7%
0%
10%
20%
30%
40%
50%
60%
70%
Male FemalePercentageFigure 53. Percent of Adults Who Have Never Smoked, by Sex, Florida, 2013
210
In Florida, the higher the educational attainment of an individual, the more likely they were to
have never smoked tobacco, while in Collier County this relationship does not strictly hold
(Figures 54 and 55). Also reversing the trend in Collier County, the lower the annual income the
more likely an individual was to have never smoked, while in Florida those with an annual
income of $50,000 or more had the highest proportion of adults who have never smoked
(Figures 56 and 57).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
53.0%
46.4%
50.3%
0%
10%
20%
30%
40%
50%
60%
70%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 54. Percent of Adults Who Have Never Smoked, by Educational Level, Collier County, 2013
211
Data Source: Behavioral Risk Factor Surveillance System, 2013.
49.5%
52.5%
57.8%
0%
10%
20%
30%
40%
50%
60%
70%
Less than high school High school graduate or
college
4+ Yrs. CollegePercentageFigure 55. Percent of Adults Who Have Never Smoked, by Educational Level, Florida, 2013
50.8%51.2%
47.5%
0%
10%
20%
30%
40%
50%
60%
70%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 56. Percent of Adults Who Have Never Smoked, by Annual Income, Collier County, 2013
212
53.8%
50.4%
58.1%
0%
10%
20%
30%
40%
50%
60%
70%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 57. Percent of Adults Who Have Never Smoked, by Annual Income, Florida, 2013
In both Collier County and Florida more than 60 percent of those 18 to 44 years of age have
never smoked. Based on historical trends these percentages are at all time high levels (Figures
58 and 59).
63.0%
41.9%
45.0%
0%
10%
20%
30%
40%
50%
60%
70%
18-44 45-64 65 & OlderPercentageFigure 58. Percent of Adults Who Have Never Smoked, by Age Group, Collier County, 2013
213
Data Source: Behavioral Risk Factor Surveillance System, 2013.
65.2%
49.8%
43.9%
0%
10%
20%
30%
40%
50%
60%
70%
18-44 45-64 65 & OlderPercentageFigure 59. Percent of Adults Who Have Never Smoked, by Age Group, Florida, 2013
214
Alcohol Use
Excessive alcohol consumption is a risk factor for numerous adverse health conditions and
outcomes. Consumption of alcohol in excessive quantities can lead to alcohol poisoning,
hypertension, heart disease, fetal alcohol syndrome, violence and its associated sequelae and
sexually transmitted diseases.
A strong association exists between alcohol consumption and alcohol impaired driving. Data
indicate that binge and heavy drinkers consistently account for most instances of alcohol -
impaired driving. Alcohol related motor vehicle collisions constitute a significant, if not a majority
of alcohol related deaths, depending upon the age-group. In Collier County, on average,
approximately 54 residents are killed annually in motor vehicle crashes (about 1 every week)
with an average of about 25 percent attributed to alcohol use.
Figure 60 shows the percent of adults who engaged in heavy or binge drinking in Collier County
and Florida in 2013. The data indicate no significant differences with Collier County at 18.1
percent and the state of Florida at 17.6 percent.
Data Source: Behavioral Risk Factor Surveillance System, 2013.
18.1%17.6%
0%
5%
10%
15%
20%
Collier FloridaPercentageFigure 60. Percent of Adults Who Engage in Heavy or Binge Drinking, Collier County and Florida, 2013
215
By sex, males engaged in heavy or binge drinking at a significantly higher rate than females in
both Collier County and Florida (Figures 61 and 62). In fact, in Florida in 2013, the ratio of the
proportion of males to females engaging in this behavior was 92 percent higher, while for Collier
County it was 52 percent greater.
Data Source: Behavioral Risk Factor Surveillance System, 2013.
22.0%
14.5%
0%
5%
10%
15%
20%
25%
Male FemalePercentageFigure 61. Percent of Adults Who Engage in Heavy or Binge Drinking, by Sex, Collier County, 2013
23.4%
12.2%
0%
5%
10%
15%
20%
25%
Male FemalePercentageFigure 62. Percent of Adults Who Engage in Heavy or Binge Drinking, by Sex, Florida, 2013
216
By ethnicity, Hispanics were 1.8 times more likely to engage in heavy or binge drinking in Collier
County than Non-Hispanics. This ratio was lower for the state of Florida at 1.2 (Figures 63 and
64).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
27.2%
15.4%
0%
5%
10%
15%
20%
25%
30%
Hispanic Non-HispanicPercentageFigure 63. Percent of Adults Who Engage in Heavy or Binge Drinking, by Ethnicity, Collier County, 2013
19.6%
15.8%
0%
5%
10%
15%
20%
25%
30%
Hispanic Non-HispanicPercentageFigure 64. Percent of Adults Who Engage in Heavy or Binge Drinking, by Ethnicity, Florida, 2013
217
In the state of Florida, a consistent correlation exists between income levels and the percentage
of the population engaged in heavy or binge drinking. The greater the income category, the
more likely a person over-consumes alcohol. In Collier County the highest prevalence of heavy
alcohol use is seen in the population earning less than $25,000 per year, while in Florida the
highest rate is found among those earning $50,000 or more (Figures 65 and 66).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
24.0%
14.4%
17.2%
0%
5%
10%
15%
20%
25%
30%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 65. Percent of Adults Who Engage in Heavy or Binge Drinking, by Annual Income,
Collier County, 2013
16.3%
17.9%
20.3%
0%
5%
10%
15%
20%
25%
30%
<$25,000 $25,000 - $49,999 $50,000 or MorePercentageFigure 66. Percent of Adults Who Engage in Heavy or Binge Drinking, by Annual Income,
Florida, 2013
218
By age groups, for both Collier County and Florida, the younger the age (18 to 44 years of age)
the higher the prevalence of heavy or binge drinking. During 2013, Collier County had a higher
proportion of the older population (65 years of age and older) than Florida engaging in heavy or
binge drinking. This may be possibly related to the relative affluence found in the county
(Figures 67 and 68).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
24.1%
22.0%
9.8%
0%
5%
10%
15%
20%
25%
30%
18-44 45-64 65 & OlderPercentageFigure 67. Percent of Adults Who Engage in Heavy or Binge Drinking, by Age Group,
Collier County, 2013
24.2%
16.9%
7.2%
0%
5%
10%
15%
20%
25%
30%
18-44 45-64 65 & OlderPercentageFigure 68. Percent of Adults Who Engage in Heavy or Binge Drinking, by Age Group,
Florida, 2013
219
By marital status, in Florida and Collier County, married couples had a significant lower
prevalence of heavy or binge drinking than non-married couples. This is a similar protective
factor that is seen among married couples when analyzing other select health related lifestyle
behaviors in the community health assessment (Figures 69 and 70).
Data Source: Behavioral Risk Factor Surveillance System, 2013.
14.6%
23.6%
0%
5%
10%
15%
20%
25%
Married/ Couple Not Married/ CouplePercentageFigure 69. Percent of Adults Who Engage in Heavy or Binge Drinking, by Marital Status,
Collier County, 2013
14.9%
20.9%
0%
5%
10%
15%
20%
25%
Married/ Couple Not Married/ CouplePercentageFigure 70. Percent of Adults Who Engage in Heavy or Binge Drinking, by Marital Status,
Florida, 2013
220
Adolescent Substance Abuse
The age of adolescence is a critical period of social, physical and mental growth. Attitudes and
behaviors are in the process of development which will have an impact on their immediate and
long term social and interpersonal relationships within the adult environment and society.
The use and abuse of substances at these crucial ages often results in important and vital
adverse health outcomes. Alcohol and other illicit substance abuse and use impedes the
adolescent’s progress towards a successful and productive future by limiting a strong sense of
school belonging and a positive adult lifestyle and family environment.
The following analyses uses the results from the 2014 Florida Youth Substance Abuse Survey
for Collier County, the most recent data available as of June 2016.
Table 1 and Figure 71 shows the percentages of adolescents 10 to 17 years of age that report
having used various drugs during their lifetime in Collier County and Florida for 2014.
Table 1. Percentage of Adolescents 10–17 years of age who Reported Having Used Various Drugs in their Lifetime,
Collier County and Florida, 2014
Collier County Florida
Alcohol 41.7 42.6
Cigarettes 17.2 17.6
Marijuana or Hashish 21.6 22.6
Synthetic Marijuana 8.7 8.8
Cocaine or Crack Cocaine 3.2 1.9
Heroin 0.8 0.6
Prescription Pain Relievers 5.1 5.5
Over-the-Counter Drugs 4.9 5
Any Illicit Drug 29 30
221
The state of Florida has a higher rate of substance use than Collier County for seven out of the
nine types of drugs. While the use of the various types of substances in Collier County was
lower for these drugs than for Florida, the largest variance was only about one percent less in
difference.
In Collier County, 3.2 percent of adolescents reported having used cocaine or crack cocaine
compared with 1.9 percent for the state of Florida, while 0.8 percent admitted to having used
heroin in Collier County compared with 0.6 percent in the state of Florida. This deviation in the
trend for Collier County compared with the lower use of the other seven types of drugs may be
attributed to the higher level of economic affluence within the community.
The trends in alcohol, tobacco and other drug use over the period of 2004 to 2014 can be seen
in Table 2 and Figure 72. Substance use for all seven categories declined in Collier County
among adolescents during the ten year period. The most significant decrease was with t obacco
−57 percent, followed by prescription pain relievers −54 percent, and alcohol only −34 percent.
In Figure 2, the sharp sloping decline is quite visible for cigarettes, alcohol and alcohol or any
illicit drug.
0 5 10 15 20 25 30 35 40 45
Alcohol
Cigarettes
Marijuana or Hashish
Synthetic Marijuana
Cocaine or Crack Cocaine
Heroin
Prescription Pain Relievers
Over-the-Counter Drugs
Any Illicit Drug
Percentages
Figure 71. Percentage of Adolescents 10–17 years of age who Reported Having Used
Various Drugs in their Lifetime, Collier County and Florida, 2014
Florida Collier County
222
Table 2. Percentage of Adolescents 10–17 years of age who reported Alcohol, Tobacco and other Drug Use,
Collier County, 2004–2014
2004 2006 2008 2010 2012 2014 Percentage change
2004–2014
Alcohol 60.9 55.8 53.6 52.3 51.2 41.7 -32
Cigarettes 40.4 31.8 29.5 28.5 23.8 17.2 -57
Marijuana or Hashish 26.1 22.4 18.6 23.1 24.3 21.6 -17
Prescription Pain Relievers 11.1 9.3 8 6.1 6.8 5.1 -54
Any Illicit Drug 36.1 31.6 30.1 31.9 31.6 29 -20
Alcohol Only 28.3 27.7 27.3 24.2 23 18.7 -34
Alcohol or any Illicit Drug 63.8 59.3 57.3 55.9 54.3 47.3 -26
0
10
20
30
40
50
60
70
2004 2006 2008 2010 2012 2014Percentage
Year
Figure 72. Percentage of Adolescents 10 –17 years of age who reported Alcohol,
Tobacco and other Drug Use, Collier County, 2004–2014
Alcohol
Cigarettes
Marijuana or
Hashish
Prescription Pain
Relievers
Any Illicit Drug
Alcohol Only
Alcohol or any
Illicit Drug
223
The percentages of adolescents 10 to 17 years of age who reported having used various drugs
in their lifetime by gender is presented in Table 3 and Figure 73. An interesting trend is visible
for both Collier County and the state of Florida in that females are more likely than males to
have used alcohol, prescription pain relievers and over-the-counter drugs in both geographical
domains. In fact in Collier County, 43.9 percent of adolescent females have used alcohol
compared with 39.6 percent of males (a difference of +4.3 percent). Also in Collier County 6.7
percent of females reported having used prescription pain relievers compared with 3.9 percent
among males (a difference of +3.1 percent). 22.9 percent of males in Collier County reported
having used marijuana or hashish; for females the percentage was 20.5 (a difference of −2.4
percent). In Collier County and in Florida, males were twice as likely to have used heroin than
females although the actual percentages were very low.
Table 3. Percentage of Adolescents 10–17 years of age who reported Having Used Various Drugs in their Lifetime,
by Gender, Collier County and Florida, 2014
Collier Florida
Female Male Female Male
Alcohol 43.9 39.6 44.3 40.9
Cigarettes 17.1 17.6 17.2 18
Marijuana or Hashish 20.5 22.9 22.1 23
Synthetic Marijuana 7.7 10.1 7.7 10
Cocaine or Crack Cocaine 3 3.5 1.6 2.1
Heroin 0.6 1.2 0.4 0.8
Prescription Pain Relievers 6.7 3.6 5.9 5.1
Over-the-Counter Drugs 6 3.9 5.1 4.8
Any Illicit Drug 28.9 29.2 30.7 29.4
224
Table 4 and Figure 74 shows the percentages of adolescents by age reporting having used
various drugs in their lifetime. As would be expected, those ages 15 to 17 years had higher
percentages of specific drug use history for all categories in both Collier County and Florida.
0
5
10
15
20
25
30
35
40
45
50
Collier County Female Collier County Male Florida Female Florida MalePercentageFigure 73. Percentage of Adolescents 10–17 years of age who reported Having Used
Various Drugs in their Lifetime, by Gender, Collier County and Florida, 2014
Alcohol
Cigarettes
Marijuana or
Hashish
Synthetic
Marijuana
Cocaine or
Crack Cocaine
Heroin
Prescription
Pain Relievers
Over-the-
Counter Drugs
Any Illicit Drug
225
Table 4. Percentage of Adolescents 10–17 years of age who reported Having Used Various Drugs in their Lifetime,
by Ages, Collier County and Florida, 2014
… Data not available
Collier Florida
Ages 10–14 Ages 15–17 Ages 10–14 Ages 15–17
Alcohol 23.9 58 26.6 56.5
Cigarettes 8.9 24.6 10 23.5
Marijuana or Hashish 8 33.7 9.2 34.1
Synthetic Marijuana … 8 … 8.9
Cocaine or Crack Cocaine 1.4 5 0.9 2.4
Heroin 0.4 1.3 0.6 0.7
Prescription Pain
Relievers 3.6 6.6 3.3 7.4
Over-the-Counter Drugs 2.8 6 3.5 6.2
Any Illicit Drug 16.6 39.3 18.7 39.9
0
10
20
30
40
50
60
70
Collier Ages 10–14 Collier Ages 15–17 Florida Ages 10–14 Florida Ages 15–17PercentagesFigure 74. Percentage of Adolescents 10–17 years of age who reported Having Used
Various Drugs in their Lifetime, by Ages, Collier County and Florida, 2014
Alcohol
Cigarettes
Marijuana or
Hashish
Synthetic
Marijuana
Cocaine or
Crack Cocaine
Heroin
Prescription
Pain Relievers
Over-the-
Counter Drugs
Any Illicit Drug
226
The correlation between alcohol or other substance use and the risk of a detrimental outcome
when driving a vehicle is universally accepted. Figure 75 compares the percentages of
adolescents in Collier County and Florida who reported driving a vehicle in the past 30 days
after drinking alcohol or using marijuana. In both the county and the state adolescents drivers
were more likely to have used marijuana than alcohol.
In Figure 76, these percentages are also calculated by gender. In Collier County, a larger
proportion of female adolescents were more likely to have driven a vehicle after using alcohol or
marijuana than males. The reverse is the case for Florida, where males were much more likely
to drive after having used marijuana than females, and a tad more likely to have driven after
drinking alcohol.
6
6.6
9.2
10.9
0
2
4
6
8
10
12
Collier County FloridaPercentageFigure 75. Percentage of Adolescents 10–17 years of age who Reported Driving a
Vehicle Within the Past 30 Days After Drinking Alcohol or Using Marijuana,
Collier County and Florida, 2014
Alcohol
Marijuana
227
6.7
5.4
6.2
6.8
9.7
9.2 9.6
12.2
0
2
4
6
8
10
12
14
Collier County Female Collier County Male Florida Female Florida MalePercentageFigure 76. Percentage of Adolescents 10–17 years of age who Reported Driving a
Vehicle Within the Past 30 Days After Drinking Alcohol or Using Marijuana, by Gender,
Collier County and Florida, 2014
Alcohol
Marijuana
228
Mental Health
Mental illnesses are defined as those health conditions that change a person’s behavior,
feelings or thinking and cause the person distress and difficulty in performing daily life functions.
Mental health is important at every stage of life and includes social, emotional and psychological
well-being. Like other diseases, mental illness can range from mild to severe. People with mild
mental illness may not display any visible signs. Despite effective treatments, there can be long
delays between the first onset of symptoms and when the person seeks treatment.
In the United States, approximately 20 percent of the people over the age of 18 suffer from a
diagnosable mental illness in a given year. Approximately 4 percent of adults have a serious
mental illness (SMI) which seriously impact their ability to function properly in society. Mental
illnesses are also not uncommon among young adults under the age of 18. Approximately half
of all children and adolescents with mental health problems do not receive proper care.
Collier County residents are surveyed about their mental health status in the Behavioral Risk
Factor Surveillance System (BRFSS) Survey. As stated in the technical note in the Health
Behaviors and Health Status chapter, the comparison of the latest 2013 county-level survey
data to any of the previous county-level BRFSS surveys (2002–2010) is not recommended. For
this reason this chapter on mental health will only use 2013 BRFSS data.
In 2013, 92.7 percent of Collier County residents reported having good mental health, about 5
percentages points higher than the proportion in Florida (Figure 1). About 7.3 percent of Collier
County residents reported having poor mental health on 14 or more of the past 30 days. For
Florida the percentage is 12.7 (Figure 2).
229
Data Source: Florida Behavioral Risk Factor Surveillance System
7.3%
12.7%
0%
2%
4%
6%
8%
10%
12%
14%PercentageFigure 2. Adults who Had Poor Mental Health on 14 or More of the Past 30 Days,
Collier County and Florida, 2013
Collier County Florida
92.7%
87.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Collier FloridaPercentage
Year
Figure 1. Adults with Good Mental Health,
Collier County, 2013
230
When analyzing the data by gender, the percentage of males reporting poor mental health days
was 4.1 in 2013, whereas 10.3 percent of females reported poor mental health days (Figure 2).
In Florida, 10.9 percent of males and 14.4 percent of females reported having had poor mental
health days.
Data Source: Florida Behavioral Risk Factor Surveillance System
Although the comparison with previous years is not recommended, it is worth mentioning that
between 2007 and 2010 the mental health status of the population in the 18 to 64 years age
group deteriorated mainly due to the effects of the economic recession of 2007. In 2013, the
percentage of people reporting poor mental health days in the 18 to 44 age group was 8.4
percent, a much lower percentage than in previous year. Adults in the 45 to 65 age group had
the highest percentages of those who reporting poor mental health days, whereas the lowest
percentages were in the older population with 5 percent (Figure 4).
4.1%
10.3%
0%
2%
4%
6%
8%
10%
12%
Male FemalePercentage
Gender
Figure 3. Adults Who Had Poor Mental Health on 14 or More of the Past 30 Days, by Gender
Collier County, 2013
231
Data Source: Florida Behavioral Risk Factor Surveillance System
Further analysis of data also displays variation by income. The highest percentage of people
reporting poor mental health days was in the less than $25,000 income group with 11.4 percent,
and the lowest percentage was in the $50,000 or more income group with 4.7 percent (Figure
5). When analyzing by education, the percentage of people reporting poor mental health days
was higher for those with a high school diploma or GED than for those with more than a high
school diploma (Figure 6).
8.4%
9.0%
5.0%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
18-44 45-64 65 and OlderPercentage
Age
Figure 4. Adults Who Had Poor Mental Health on 14 or More of the Past 30 Days,
By Age Group, Collier County, 2013
232
Data Source: Florida Behavioral Risk Factor Surveillance System
11.4%
8.6%
4.7%
0%
2%
4%
6%
8%
10%
12%
<$25,000 $25,000-$49,999 $50,000 or MorePercentage
Income
Figure 5. Adults Who Had Poor Mental Health on 14 or More of the Past 30 Days, by Income,
Collier County, 2013
9.1%
7.7%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
High School/GED More Than High SchoolPercentage
Education
Figure 6. Adults Who Had Poor Mental Health on 14 or More of the Past 30 Days,
by Education, Collier County, 2013
233
Suicide
Suicide is a significant preventable public health problem in the United States. It is now the
second leading cause of death among persons aged 10 to 34 years, and the fourth leading
cause of death among person aged 35 to 54 years. In Collier County, suicide was ranked as the
10th leading cause of death in 2014. Several risk factors including history of depression or other
mental illnesses, family history of suicide and previous suicide attempts can increase the
likelihood of someone attempting or dying from suicide.
In Collier County, between 2005 and 2014, there was a slight decrease in suicide deaths, from
9.8 deaths per 100,000 population to 9.3 deaths per 100,000 population. For Florida, during the
same time period, suicide deaths increased by 13 percent, from 12.3 deaths per 100,000 to
13.9 deaths per 100,000 population (Figure 7).
Data Source: Bureau of Vital Statistics, Florida Department of Health, Tallahassee, FL
0
2
4
6
8
10
12
14
16
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Collier
County
Florida
Collier
County
Linear trend
Florida
Linear Trend
Figure 7. Number of Deaths due to Suicide per 100,000 Population, Adjusted for Age,
Collier County and Florida, 2005–2014
234
Further analysis of data shows major differences in suicide deaths for males and females. In
Collier County between 2005 and 2014, there was a 6.7 percent increase in suicide deaths
among males, from 15 deaths per 100,000 population to 16 deaths per 100,000 population. For
females during the same period, suicide deaths declined by 38 percent, from 5 deaths per
100,000 population to 3.1 deaths per 100,000 population. In Collier County, death rate from
suicide for males was 5 times higher than females in 2014. The death rate from suicide for
females in Collier County (6.3 death per 100,000 population) was less than three times the
overall rate for males in Florida (22 deaths per 100,000 population) in 2014 (Figure 8).
Data Source: Bureau of Vital Statistics, Florida Department of Health, Tallahassee, FL
In Collier County between 2005 and 2014, suicide deaths for whites slightly decreased, from
10.3 deaths per 100,000 population to 10.1 deaths per 100,000 population. For Florida, suicide
deaths for whites increased by 14 percent during the same time period, from 13.9 deaths per
100,000 population to 15.8 deaths per 100,000 population (Figures 9).
0
5
10
15
20
25
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Male
Female
Male Linear
Trend
Female
Linear Trend
Figure 8. Number of Deaths due to Suicide per 100,000 Population, Adjusted for Age, by Gender
Collier County, 2005–2014
235
Data Source: Bureau of Vital Statistics, Florida Department of Health, Tallahassee, FL
The death rate from suicide for non-Hispanics decreased by 10.7 percent in Collier County, from
13.1 deaths per 100,000 population in 2005 to 11.7 deaths per 100,000 population in 2014.
During the same time period, the death rate from suicide for Hispanics increased from 0 deaths
per 100,000 in 2005 to 2.7 deaths per 100,000 in 2014 (Figure 10). The death rate from suicide
for non-Hispanics in Collier County was 4.3 times the rate of Hispanics in 2014. The death rate
from suicide for Hispanics in Florida was twice the rate for Hispanics in Collier County in 2014.
0
2
4
6
8
10
12
14
16
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
White
Non-White
White Linear
Trend
Non-White
Linear Trend
Figure 9. Number of Deaths due to Suicide per 100,000 Population, Adjusted for Age, by Race
Collier County, 2005–2014
236
Data Source: Bureau of Vital Statistics, Florida Department of Health, Tallahassee, FL
Between 2005 and 2014, death rate from suicide for the 18 to 44 age group declined by 28
percent, from 7.5 deaths per 100,000 population to 9.6 deaths per 100,000 population. The rate
for the 45 to 64 age group increased by 7.4 percent, from 18.9 deaths per 100,000 population to
20.3 deaths per 100,000 population. The death rate from suicide for the 65 and older age group
decreased by 30.5 percent during the same time period (Figure 11).
0
2
4
6
8
10
12
14
16
18
20
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
Hispanic
Non-
Hispanic
Hispanic
Linear Trend
Non-Hispanic
Linear Trend
Figure 10. Number of Deaths due to Suicide per 100,000 Population, Adjusted for Age ,
by Ethnicity, Collier County, 2005–2014
237
Data Source: Bureau of Vital Statistics, Florida Department of Health, Tallahassee, FL
0
5
10
15
20
25
30
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100,000Year
18 - 44
45 - 64
65 and Older
Figure 11. Number of Deaths due to Suicide per 100,000 Population, by Age
Collier County, 2005–2014
238
Mental Health Resources in Collier County
Collier County has four facilities which provide psychiatric/substance abuse services to local
residents. These four facilities offer a combined total of 201 treatment beds for these services
(Table 1).
Table 1. Number of Substance Abuse/Psychiatric Beds by Facility, Collier County, 2014
Data Source: Florida Department of Health in Collier County, Epidemiology Program.
All facilities except Naples Community Hospital (NCH) offer both inpatient and outpatient
treatment services. NCH only offers inpatient treatment services.
Facility Substance
Abuse Beds
Psychiatric
Beds
Dual Use
Beds Total Beds
Hazelden 47 -- -- 47
The Willough of
Naples 5 82 -- 87
David Lawrence
Center 30 24 -- 54
Naples Community
Hospital -- -- 13 13
239
Oral Health
Oral health is essential to a person’s overall health, well-being and quality of life. Significant
improvements in oral health in the United States over the past 50 years have been primarily due
to effective treatment and prevention efforts, which includes community water fluoridation.
However, despite major improvements, accessibility to oral health care in those with lower
levels of income and education is a challenge.
In Collier County, between 2002 and 2013, the number of dentists increased by 59.5 percent,
from 40 dentists per 100,000 population to 63.8 dentists per 100,000 population. For Florida,
during the same time period, the number of dentists increased by 2.3 percent (Figure 1).
Data Source: Florida Department of Health, Division of Medical Quality Assurance.
The majority of dental care in Collier County is provided by dentists in private practice.
Individuals with private insurance or those who can afford to pay out of pocket choose providers
in private practice to get dental care. Low reimbursement rates discourage the vast majority of
private practice dental providers from accepting Medicaid. People without private insurance and
who cannot afford out-of-pocket expenses receive care at the County Health Department or
0
10
20
30
40
50
60
70
80
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013Rate per 100, 000 PopulationYear
Collier
Florida
Figure 1. Total Licensed Dentists, Collier County and Florida, 2002–2013
240
federally qualified health centers. In 2015, there were only 6 dental centers in Collier County
who accepted Medicaid.
The only dental care option for many low income people who lack access to preventative dental
services is hospital emergency rooms. In 2014, 628 Collier County residents visited hospital
emergency rooms for dental conditions considered avoidable with proper preventative dental
care (Table 1). The total cost of all these visits was $833,256. Between 2012 and 2014, dental
emergency room visits in Collier County decreased by 7.5 percent while the associated cost per
dental ER visit increased by 40 percent.
Table 1. Emergency Room Dental Visits and Associated Hospital Charges, Collier County, 2012 and 2014.
2012 2014
Number of ER Dental Visits 679 628
Total Associated Charges $642,537 $833,256
Cost per ER Dental Visit $946 $1,327
Data Source: Agency for Health Care Administration
Figures 2 and 3 display the number of emergency department (ED) dental visits by age groups
for 2011 and 2012. The highest number of ED dental visits were among those 20 to 34 years
old with more than 500 visits each year. Among ages 0 to 4, one- and two-year-olds accounted
for about two out of three ED dental visits.
241
Data Source: Florida Public Health Institute
0
100
200
300
400
500
600
700
0-19 20-34 35-49 50-64 65+NumberAge Group
Figure 2. Number of Emergency Department Dental Visits by Age Group,
Collier County, 2011 and 2012
2011
2012
0
5
10
15
20
25
30
35
40
45
<1 1 2 3 4Number
Age
Figure 3. Number of Emergency Department Visits by Young Children for Preventable
Conditions, by Ages <1 -4, Collier County, 2011 and 2012
2011
2012
242
In Collier County, between 2005 and 2014, there was 185.7 percent increase in hospitalizations
from preventable dental conditions for people under 65 years of age, from 2.1 per 100,000
population to 6 per 100,000 population. For Florida, during the same time period, the rate
increased by 49.3 percent from 7.7 per 100,000 population to 11.5 per 100,000 population
(Figure 4).
Data Source: Florida Agency for Health Care Administration
0
2
4
6
8
10
12
14
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Rate per 100, 000 PopulationYear
Collier
Florida
Figure 4. Preventable Hospitalizations Under 65 Years of Age from Dental Conditions Per
100,000, Single Year Rates, Collier County and Florida, 2005–2014
243
Community Water Fluoridation
The Centers for Disease Control and Prevention (CDC) recognized community water
fluoridation as one of 10 great public health achievements of 20th century. Community water
fluoridation is the adjustment of existing fluoride level in the drinking water to a level (0.7-1.2
parts per million) recommended by the U.S. Public Health Service. In 2012, it served nearly 75
percent of people in the United States who use the public water supplies. The American Dental
Association endorses community water fluoridation as a safe and effective way of preventing
tooth decay. In 2012, 79.8% of Collier County residents received optimally fluoridated water
compared to 76.6% for all Florida residents (Figure 5).
Data Source: Florida Department of Health, Bureau of Environmental Health, Tallahassee, FL.
0
10
20
30
40
50
60
70
80
90
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012Percentage
Year
Collier
County
Florida
Figure 5. Population With Fluoridated Water Supplies,
Collier County and Florida, 2003–2012
244
Dental Care Resources in Collier County
The majority of dental providers in Collier County work in private practice settings; however,
there are number of other dental care resources which mainly serve the needs of low income
residents of Collier County.
Florida Department of Health in Collier County Dental Clinic
The Florida Department of Health in Collier County (FDOH-Collier) Dental Clinic opened its
dental clinic in January 2001. Initially the clinic had one full time dentist, two dental assistants
and three chairs for treatment as it only provided services to children under the age of 21. At the
end of 2002, the clinic began providing services to adults. The clinic has grown over the years
and currently has 13 full-time staff including three dentists, one hygienists, seven dental
assistants and two clerks. The clinic also has a part-time dental hygienist in the tooth fairy
program which provides oral health education to Collier County children.
In 2015, the clinic served a total of 2,954 dental patients. Figure 6 through 9 show the
distribution of FDOH-Collier Dental Clinic users by age groups, gender, race and ethnicity.
245
Data Source: Florida Department of Health in Collier County Dental Clinic
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
<1 1-4 5-14 15-24 25-44 45-64 ≥65Percentage
Age Group
Figure 6. Percentage Distribution of FDOH-Collier Dental Clinic Users by Age Group,
Collier County, 2005 and 2014
2005
2014
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014Percentage
Year
Figure 7. Percentage Distribution of FDOH-Collier Dental Clinic Users, by Gender,
Collier County, 2005–2014
Male
Female
Total
246
Data Source: Florida Department of Health in Collier County Dental Clinic
0%
10%
20%
30%
40%
50%
60%
70%
80%
Hispanic or Latino Non-Hispanic/Latino UnknownPercentage
Ethnicity
Figure 9. Percentage Distribution of FDOH-Collier Dental Clinic Users by Ethnicity,
Collier County, 2005 and 2014
2005
2014
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
White Black OtherPercentage
Race
Figure 8. Percentage Distribution of FDOH-Collier Dental Clinic Users by Race,
Collier County, 2005 and 2014
2005
2014
247
Healthcare Network of Southwest Florida
The Healthcare Network of Southwest Florida provides dental care services to low income
children and families at its locations in Immokalee and East Naples and its mobile office, the
Health & Smiles Mobile. A new location is set to open April 2016.
Ronald McDonald Care Mobile
The Ronald McDonald Care Mobile began providing services in November, 2004. It is a
partnership between the Healthcare Network of Southwest Florida and Ronald McDonald House
Charities of Southwest Florida. It visits locations throughout Collier County and provides medical
and dental care to low income children.
Naples Children and Education Foundation Pediatric Dental Center
The center is the collaboration between the Naples Children and Education Foundation,
Healthcare Network of Southwest Florida, Florida Southwestern State College (Collier Campus)
and the University Of Florida College Of Dentistry. The center provides specialized dental care
to children and is staffed by the University of Florida Pediatric Dentistry residency trainees.
Services for Adults
Several options also exist for adults; however, the options are limited by the number of available
appointments and/or hours and days of operation. The DOH–Collier County provides
emergency services to adults on a daily basis but has limited appointment availability for
preventative and restorative work. The Senior Friendship Center and the Neighborhood Health
Clinic provide dental care for adults but have limited hours and days of operation.
248
The Health of the Older Population
The older population of Collier County (persons 65 years and above) numbered 92,125 in 2014.
This represents 27.1 percent of the total county population or over one in every four residents.
The number of older Collier County residents increased by 48 percent since 2000, compared to
an increase of 29 percent for the under 65 population. It is worth noting that the number of
residents 45 to 64 years of age who will reach 65 to 84 over the next 10 years increased by 42
percent during this period.
The sex ratio distribution of the population 65 years and over in 2014 was 115 females to every
100 males. This ratio increases with age due to the greater margin of life expectancy that the
females have over the male population.
Since 1990, the percentage of residents in Collier County ages 65 and over has increased by
162 percent, from 35,182 to 92,125 in 2014. The median age of the population is getting older
while the population cohort 65 years of age and over has been experiencing rapid growth. In
2014, the 65–74 age group in Collier County numbered 48,479 which is 2.2 times larger than it
was in 1990. Concurrently, the 75-84 age group is 3 times larger and the 85 years and over age
group is 5.3 greater than it was in 1990. In 2013, persons in Collier County who reached age 65
had an average additional life expectancy of 24.2 years; 25.4 years for females and 23.0 years
for males.
During the period 1990 to 2014, mortality rates continued to decline for the population 65 to 84
years of age, for men the decrease was 38 percent at ages 65 to 74 and 44 percent for ages 75
to 84. For females, at ages 65–74 the decrease was 35 percent and 44 percent for ages 75 to
84.
Life expectancy at age 65 has increased by 2.2 years for males and by 2.3 years for females
since 2000. However, recent findings mentioned earlier in the life expectancy section raise
concerns regarding future potential gains in life expectancy at birth and other ages primarily due
to prior smoking history and the long term prevalence levels of obesity, particularly for women
ages 50 and above in lower socioeconomic sub-groups of the population.
249
As mentioned earlier in the section describing population dynamics and demographics, the
number of older persons has started to increase as a result of the Baby Boomer cohort turning
65 years of age in the 2010s. This will cause a significant exponential growth in this older age
group thru the year 2030. These dramatic rates of growth in population among the 65 years and
older ages are visible in Figure 1.
Data Source: U.S. Census Bureau
The population of Collier County 65 years and above in 2040 is projected to be 1.6 times as
large as it was in the year 2014, growing from 92,752 in 2014 to 145,893 in 2040. In 2040, the
population of 65 years and above will consist of approximately 30 percent of the total county
population in that year (Table 1).
All of the age groups among the 65 years and above population are projected to increase at
levels through 2040 (Figure 2).
0
50
100
150
200
250
300
350
400
450
500
1990–2000 2000–2010 1990–2014Percentage ChangeYear
65+
65–74
75–84
85+
Figure 1. Percentage Change in the Population 65 Years of Age and Older by
Select Older Age Groups, Collier County, 1990–2014
250
Table 1. Population by Age Distribution, Collier County, 2014, 2020, 2030 and 2040
Age Group 2014 2020 2030 2040
< 65 244,031 247,738 262,999 289,531
65+ 92,752 95,498 113,143 145,893
65–74 48,510 49,515 54,897 68,051
75–84 32,754 33,900 42,618 52,347
85+ 11,488 12,083 15,628 25,495
Data Source: Bureau of Economic and Business Research, Florida Population Studies, Bulletin 163 32.676.531.996.9206.60
50
100
150
200
250
< 65 65+65–74 75–84 85+Percentage ChangeAge Group
Figure 2. Percentage Change in the Population by Select Age Groups,
Collier County, 2014–2040
251
Leading Causes of Death
Cancer remains the leading cause of death in Collier County and Florida, with heart disease and
Alzheimer’s disease as close second and third leading causes of death, respectively. In 2014,
cancer accounted for 25.2 percent of all deaths 65 years and over in Collier County and almost
22 percent in Florida. In the county, among males 65 years and over cancer accounted for
approximately 27.5 percent of all deaths, while among females it caused over 22.7 percent of all
deaths.
Tables 2 to 13 show the 10 leading causes of death among the older population by age groups
and gender in Collier County.
252
Table 2. The 10 Leading Causes of Death, 65 Years and Over, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Cancer 647 25.19% 702.3
Heart Diseases 594 23.13% 644.8
Alzheimer's Disease 185 7.20% 200.8
Chronic Lower
Respiratory Disease 164 6.39% 178.0
Cerebrovascular
Diseases 156 6.07% 169.3
Unintentional Injury 118 4.60% 128.1
Diabetes Mellitus 49 1.91% 53.2
Parkinson's Disease 45 1.75% 48.8
Essen Hypertension &
Hypertensive Renal
Disease
28 1.09% 30.4
Influenza & Pneumonia 25 0.97% 27.1
Table 3. The 10 Leading Causes of Death, 65–74 Years, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Cancer 190 38.93% 391.9
Heart Diseases 84 17.21% 173.3
Chronic Lower
Respiratory Disease 43 8.81% 88.7
Cerebrovascular
Diseases 22 4.51% 45.4
Diabetes Mellitus 18 3.69% 37.1
Unintentional Injury 13 2.66% 26.8
Chronic Liver Disease &
Cirrhosis 12 2.46% 24.8
Alzheimer's Disease 11 2.25% 22.7
Essen Hypertension &
Hypertensive Renal
Disease
6 1.23% 12.4
Suicide 5 1.02% 10.3
Data Source: U.S. Census Bureau, Bureau of Vital Statistics
253
Table 4. The 10 Leading Causes of Death, 75–84 Years, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Cancer 265 32.76% 827.8
Heart Diseases 159 19.65% 496.7
Cerebrovascular
Diseases 50 6.18% 156.2
Chronic Lower
Respiratory Disease 47 5.81% 146.8
Unintentional Injury 34 4.20% 106.2
Alzheimer's Disease 33 4.08% 103.1
Parkinson's Disease 20 2.47% 62.5
Diabetes Mellitus 13 1.61% 40.6
In Situ, Benign, Uncertain
and Unknown Behavior
Neoplasms
11 1.36% 34.4
Chronic Liver Disease &
Cirrhosis 8 0.99% 25.0
Table 5. The 10 Leading Causes of Death, 85 Years and Over, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Heart Diseases 351 27.62% 3,016.76
Cancer 192 15.11% 1,650.19
Alzheimer's Disease 141 11.09% 1,211.86
Cerebrovascular
Diseases 84 6.61% 721.96
Chronic Lower
Respiratory Disease 74 5.82% 636.01
Unintentional Injury 71 5.59% 610.23
Parkinson's Disease 22 1.73% 189.08
Influenza & Pneumonia 19 1.49% 163.30
Diabetes Mellitus 18 1.42% 154.71
Essen Hypertension &
Hypertensive Renal
Disease
16 1.26% 137.52
Data Source: U.S. Census Bureau, Bureau of Vital Statistics
254
Table 6. The 10 Leading Causes of Death, 65 Years and Over Males, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Cancer 366 27.48% 853.5
Heart Diseases 341 25.60% 795.2
Alzheimer's Disease 73 5.48% 170.2
Chronic Lower
Respiratory Disease 73 5.48% 170.2
Cerebrovascular
Diseases 68 5.11% 158.6
Unintentional Injury 57 4.28% 132.9
Parkinson's Disease 30 2.25% 70.0
Diabetes Mellitus 26 1.95% 60.6
Influenza & Pneumonia 17 1.28% 39.6
Chronic Liver Disease &
Cirrhosis 12 0.90% 28.0
Table 7. The 10 Leading Causes of Death, 65 Years and Over Females, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Cancer 281 22.73% 570.7
Heart Diseases 253 20.47% 513.8
Alzheimer's Disease 112 9.06% 227.5
Chronic Lower
Respiratory Disease 91 7.36% 184.8
Cerebrovascular
Diseases 88 7.12% 178.7
Unintentional Injury 61 4.94% 123.9
Diabetes Mellitus 23 1.86% 46.7
Essen Hypertension &
Hypertensive Renal
Disease
16 1.29% 32.5
Parkinson's Disease 15 1.21% 30.5
In Situ, Benign, Uncertain
and Unknown Behavior
Neoplasms
11 0.89% 22.3
Data Source: U.S. Census Bureau, Bureau of Vital Statistics
255
Table 8. The 10 Leading Causes of Death, 65–74 Years Males, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Cancer 111 39.36% 500.4
Heart Diseases 56 19.86% 252.5
Chronic Lower
Respiratory Disease 21 7.45% 94.7
Cerebrovascular
Diseases 11 3.90% 49.6
Unintentional Injury 10 3.55% 45.1
Diabetes Mellitus 9 3.19% 40.6
Chronic Liver Disease &
Cirrhosis 8 2.84% 36.1
Alzheimer's Disease 6 2.13% 27.0
Suicide 3 1.06% 13.5
Essen Hypertension &
Hypertensive Renal
Disease
2 0.71% 9.0
Table 9. The 10 Leading Causes of Death, 65–74 Years Females, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Cancer 79 38.35% 300.4
Heart Diseases 28 13.59% 106.5
Chronic Lower
Respiratory Disease 22 10.68% 83.7
Cerebrovascular
Diseases 11 5.34% 41.8
Diabetes Mellitus 9 4.37% 34.2
Alzheimer's Disease 5 2.43% 19.0
Chronic Liver Disease &
Cirrhosis 4 1.94% 15.2
Essen Hypertension &
Hypertensive Renal
Disease
4 1.94% 15.2
Unintentional Injury 3 1.46% 11.4
In Situ, Benign, Uncertain
and Unknown Behavior
Neoplasms
2 0.97% 7.6
Data Source: U.S. Census Bureau, Bureau of Vital Statistics
256
Table 10. The 10 Leading Causes of Death, 75–84 Years Males, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Cancer 148 32.46% 954.1
Heart Diseases 99 21.71% 638.2
Cerebrovascular
Diseases 27 5.92% 174.1
Chronic Lower
Respiratory Disease 22 4.82% 141.8
Unintentional Injury 17 3.73% 109.6
Alzheimer's Disease 15 3.29% 96.7
Parkinson's Disease 13 2.85% 83.8
Diabetes Mellitus 8 1.75% 51.6
In Situ, Benign, Uncertain
and Unknown Behavior
Neoplasms
5 1.10% 32.2
Chronic Liver Disease &
Cirrhosis 4 0.88% 25.8
Cancer 148 32.46% 954.1
Table 11. The 10 Leading Causes of Death, 75–84 Years Females, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Cancer 117 33.14% 709.1
Heart Diseases 60 17.00% 363.7
Chronic Lower
Respiratory Disease 25 7.08% 151.5
Cerebrovascular
Diseases 23 6.52% 139.4
Alzheimer's Disease 18 5.10% 109.1
Unintentional Injury 17 4.82% 103.0
Parkinson's Disease 7 1.98% 42.4
In Situ, Benign, Uncertain
and Unknown Behavior
Neoplasms
6 1.70% 36.4
Aortic Aneurysm &
Dissection 5 1.42% 30.3
Diabetes Mellitus 5 1.42% 30.3
Data Source: U.S. Census Bureau, Bureau of Vital Statistics
257
Table 12. The 10 Leading Causes of Death, 85 and Over Males, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Heart Diseases 186 31.31% 3,583.82
Cancer 107 18.01% 2,061.66
Alzheimer's Disease 52 8.75% 1,001.93
Cerebrovascular
Diseases 30 5.05% 578.03
Chronic Lower
Respiratory Disease 30 5.05% 578.03
Unintentional Injury 30 5.05% 578.03
Parkinson's Disease 15 2.53% 289.02
Influenza & Pneumonia 13 2.19% 250.48
Diabetes Mellitus 9 1.52% 173.41
Essen Hypertension &
Hypertensive Renal
Disease
7 1.18% 134.87
Table 13. The 10 Leading Causes of Death, 85 and Over Females, Collier County, 2014
Ten Leading Causes of
Death
Number of
Deaths
Percentage
Distribution
Age Specific
Death Rate
Heart Diseases 165 24.37% 2560.1
Alzheimer's Disease 89 13.15% 1380.9
Cancer 85 12.56% 1318.9
Cerebrovascular
Diseases 54 7.98% 837.9
Chronic Lower
Respiratory Disease 44 6.50% 682.7
Unintentional Injury 41 6.06% 636.2
Diabetes Mellitus 9 1.33% 139.6
Essen Hypertension &
Hypertensive Renal
Disease
9 1.33% 139.6
Nephritis, Nephrotic
Syndrome, Nephrosis 7 1.03% 108.6
Parkinson's Disease 7 1.03% 108.6
Data Source: U.S. Census Bureau, Bureau of Vital Statistics
258
Alzheimer’s Disease
Alzheimer’s disease is the most common cause of dementia and can account for up to 80
percent of all cases of the condition. The definitive cause of Alzheimer’s is unknown at this time;
however, as in other chronic diseases, it is widely accepted that multiple factors are involved in
the development of the disease.
Advance age is the predominant risk factor and correlate for the development of Alzheimer’s.
The majority of persons with Alzheimer’s disease are diagnosed at age 65 and above. The
prevalence of the disease increases exponentially as age increases beyond 65 years. The
number of residents of Collier County diagnosed with Alzheimer’s as well as other dementias
will increase every year, as the percentage of the population 65 years and over continues to
grow. This number will intensify greatly through 2030 and 2040, as the “Baby Boomer” cohort
matures.
According to national estimates, almost half of the population ages 85 and older or about 5,400
residents are presently living with Alzheimer’s disease. Between the ages 65 to 84 years, the
prevalence rate is 8.2 percent, which translates into about 6,804 of this age group with the
disease. By 2030, using conservative population estimates and assuming current rates of
growth, almost 18,700 Collier County residents 65 years and over will be diagnosed with
Alzheimer’s disease (Table 14). Approximately 47 percent of these cases are 65 to 84 years of
age, and 53 percent or almost 10,000 residents are 85 years and older.
Table 14. Projections of the Number of Residents with Alzheimer’s Disease by Age, Collier County, 2015–2030
Age Group 65 and Over 65–84 85+
2015 12,204 6,804 5,400
2020 14,428 7,818 6,610
2025 16,096 7,479 8,617
2030 18,672 8,712 9,960
Data Source: U.S. Department of Health and Human Services, Florida Legislative Office of Economic and Demographic Research.
Note: Prevalence rates were calculated by applying the current United States accepted standard prevalence of Alzheimer’s disease by age 65 years
and over, applied to the projected Collier County population data from the Florida Legislative Office of Economic and Demographic Research.
259
Alzheimer’s disease is the third leading cause of death in the population 65 years of age and
older. In 2014, this cause of mortality accounted for 7.2 percent of all deaths 65 years of age
and over in Collier County and just over 4.1 percent of deaths in the older population in Florida.
Among the population 85 years and older, Alzheimer’s disease accounted for 11.1 percent of all
causes of death in the county. Death from Alzheimer’s accounted for more deaths than stroke,
chronic lower respiratory disease, unintentional injuries, diabetes and influenza and pneumonia
for the same time period.
As the prevalence of Alzheimer’s disease has increased over the last half of the 20th and into
the 21st century, concurrent mortality from this illness has risen dramatically (Figure 3). The age-
adjusted death rate for Alzheimer’s disease in Collier County increased by 146 percent between
1995 and 2014. The death rate for Florida during the same time period increased by 167
percent.
Data Source: U.S. Census Bureau, Bureau of Vital Statistics
0
5
10
15
20
25
30
1990–92 1993–95 1996–98 1999–01 2002–04 2005–07 2008–10 2011–13Rate per 100, 000 PopulationYear
Collier
Florida
Figure 3. Number of Deaths due to Alzheimer's Disease Adjusted for Age per 100,000
Population, 3–Year Rolling Rates, Collier County and Florida, 1990–2014
260
Females are more likely to be diagnosed with Alzheimer’s disease and other dementias than
males. Approximately 2 out of every 3 Americans with Alzheimer’s disease are females at the
present time. The Alzheimer’s disease mortality rates are consistently higher in females than in
males for both the county and the state (Figure 4). In Collier County, between 2004 and 2013
the age adjusted mortality rate for Alzheimer’s disease increased by 82 percent for males and
by 109 percent for females. During the same time period, male and female deaths from
Alzheimer’s disease for the State of Florida remained constant. The prevalence and incidence
of Alzheimer’s disease is being driven by increased life expectancy over the past 60 years
particularly among women.
Data Source: U.S. Census Bureau, Bureau of Vital Statistics
0
5
10
15
20
25
30
35
2003-05 2006-08 2009-11 2012-14Rate per 100, 000 PopulationYear
Collier Male
Collier Female
Florida Male
Florida Female
Figure 4. Number of Deaths due to Alzheimer's Disease per 100,000 Population Adjusted by
Age, 3-Year Rolling Rates by Gender, Collier County and Florida, 2003 –2014
261
In 2015, nursing homes and assisted living facilities in Collier County had a total bed capacity of
3,035 beds. This results in a ratio of 32 beds per 1,000 population 65 years and older in the
county (Table 15). By type of facility, 71.8 percent of beds were found in assisted living facilities
while 28.2 percent existed within skilled nursing facilities.
Table 15. Number of Nursing Homes and Assisted Living Facilities, Collier County, 2015
Type of Facility Number of Facilities Total Number of Beds Total Number of Beds per 1,000
Population 65 Years and Older
Assisted Living Facility 28 2,083 22.0
Nursing Homes (Skilled
Nursing) 11 952 10.0
Total All Facilities 39 3,035 32.0
There is a total of 793 Alzheimer’s/dementia beds in Collier County. This amounts to 26.1
percent of the total number of long-term care beds or about 1 in every 4 of these beds in Collier
County. The ratio of Alzheimer’s and dementia beds per 1,000 population 65 years and older in
Collier County was 8.4 or about 1 bed for every 100 persons 65 years and over (Table 16).
There is clearly a current deficit of needed beds considering an existing Alzheimer’s prevalence
rate of 13 percent.
Table 16. Number of Memory Care/ Alzheimer’s/ Dementia Type Beds Available within Facilities,
Collier County, 2015
Number of Beds Percentage of All Long Term Care Beds
Available
Alzheimer’s/Dementia Beds per
1,000 Population 65 Yr. and Older
793 26.1% 8.4
Data Source: AHCA and our Collier County Long-Term Care Facilities
262
Mortality Indicators
Throughout the 20th century and through the present, the United States, Canada, Europe,
Australia, New Zealand and select Asian countries have experienced a period of unprecedented
gains in longevity and health status. At the beginning of the 1900s, life expectancy in these
developed areas was typically 45 to 50 years at birth, similar to Africa today. By the end of the
century, life expectancy at birth had increased significantly in most industrialized countries,
including the US.
Females experience a life expectancy on the order of approximately five percent longer than
males. While we have seen an increase in life expectancy on the order of more than 50 percent
over the past century, gains have been different among varying population groups.
Epidemiologically, there has been an emergence of inequalities in the average number of years
lived after birth, notably between men and women and between the higher educated and the
poorest and the more vulnerable groups.
Life Expectancy
Life expectancy of a population at birth is the average number of years that a newborn is
expected to live given the existing mortality rates at the time of birth. The methodology of life
expectancy can also be applied to the average expected number of years of life remaining at a
specific age. The level of life expectancy at birth and at other ages is an overall measure of
health status and wellbeing influenced directly by education and its socioeconomic correlates
such as income level, occupation and access to healthcare. Life expectancy is a health and
demographic indicator that can be compared by age, sex, ethnicity, race and socioeconomic
status as well as between geographical, county, state and national areas.
In Collier County, we have the distinction at the time of this writing of having the second highest
female life expectancy at birth among all of the 3,143 counties in the country. Men in Collier
County also have a very high level of life expectancy when compared nationally, only surpassed
by ten other counties in the United States.
Between 1990 and 2014, life expectancy in Collier County increased by 6 years, exceeding the
national average significantly by 7 percent. Males in Collier County experienced a greater rate
263
of life expectancy increase than females during the 24 year period; however, females continued
to maintain a significantly higher level of life expectancy at birth than males, 86.9 years
compared to 81.9 years, respectively. (Tables 1 and 2). This dominance in longevity levels by
females has been a biological reality historically throughout the world since life expectancy
calculations were first developed during the 1600s.
Table 1. Life Expectancy at Birth, Collier County, 1990, 2000 and 2014
Percentage
change,
1990 - 2000
Percentage
change,
2000 - 2014 1990 2000 2014
Life Expectancy at
Birth in Years 78.4 81.3 3.7 84.4 3.8
Table 2. Life Expectancy at Birth, by Sex, Collier County, 1990, 2000 and 2014
1990 2000 2014
Males Females Males Females Males Females
Life Expectancy at Birth in
Years 74.4 83.0 78.5 84.3 81.9 86.9
In Collier County, a 25 year old woman can expect to live 62.6 years longer, while the remaining
life expectancy for men at the same age is 58.1 years, a difference of 4½ years. Years of life
expectancy anticipated after age 25 in the US is strongly associated statistically with the number
of years of educational attainment combined with this variable’s many intercorrelated factors
(Figure 1).
264
Data Source: U.S. Census Bureau, Bureau of Vital Statistics. Calculations performed by FDOH – Collier County, Epidemiology Program
While Collier County’s life expectancy levels are among the best in the United States, over the
past 25 years, regional disparities in the longevity in women have resulted in declines in life
expectancy in various geographical areas of the country. For the first time in the history of the
country, life expectancy has actually declined over the past two decades for women in 313 US
counties, about 10 percent of the counties in the country. This decrease in female life
expectancy is occurring mostly in select counties in the Southeast, the Southern Midwest and
Appalachia.
Further analysis indicates that in the United States, since 1990 white woman who are non-
Hispanic without a high school degree lost 5 years of life expectancy at birth, while white non-
Hispanic men with less than a high school education lost three years of longevity during the
1990 to 2008 period. These declines in these levels of life expectancy within these population
sub-groups are directly associated with the level of educational attainment, which statistically
predicts income level and its correlated improvements in health behaviors and life style. These
62.6
60.0
59.3
58.1
55.3
51.6
60.3
57.6
55.2
0 10 20 30 40 50 60
2014
2000
1990
Years
Figure 1. Life Expectancy at Age 25, by Sex, Collier County, 1990, 2000 and 2014
Both Sexes
Males
Female
265
dramatic fluid change in levels of life expectancy imply that children born today in many parts of
the US among some socioeconomic subgroups of the population can expect to life shorter lives
than their parents. This is the first time in recorded public health history that life expectancy
within a significant component of the population has declined in the nation.
The variation in life expectancy at various ages in Collier County by ethnicity is shown in Figure
2 and Table 3. On average, in 2014, Hispanic residents of Collier County lived almost 1.5 years
longer than non-Hispanics over the course of a life time. This difference in the life expectancy at
birth value will change year to year as it is dependent upon the annual age-specific mortality
rates. The significantly lower infant mortality among Hispanics in the county contributed heavily
to the higher level of overall life expectancy.
85.2
83.8
84.4
61
59.9
60.3
41.8
41.3
41.4
23.7
24
24
9.1
9.2
9.2
0 20 40 60 80 100
Hispanics
Non- Hispanics
Total Life Expectancy
Years
Figure 2. Life Expectancy at Select Ages, by Ethnicity,Collier County, 2014
At 85 years or
Over
At Age 65
At Age 45
At Age 25
At Birth
266
Table 3. Life Expectancy in Collier County at Select Ages, by Ethnicity, 2014
Life Expectancy by Age Hispanics Non- Hispanics Total Life Expectancy
by Age
At Birth 85.2 83.8 84.4
At Age 25–29 61.0 59.9 60.3
At Age 45–49 41.8 41.3 41.4
At Age 65–69 23.7 24.0 24.0
At 85 years or Over 9.1 9.2 9.2
Data Source: U.S. Census Bureau, Bureau of Vital Statistics. Calculations performed by FDOH – Collier County, Epidemiology Program
This trend of higher life expectancy levels among the Hispanic population is supported by
national US data from the National Centers for Health Statistics of the Centers for Disease
Control. The most recent health statistics for the US indicate that the Hispanic population has a
life expectancy advantage at birth of 2.7 years over the non-Hispanic white population.
This Hispanic survival advantage in longevity increases with age to the effect that by age 65,
91.5 percent of the Hispanic resident population in Collier County have survived competing
causes of mortality compared with 87.8 percent of the non-Hispanic population, a differential of
3.7 percent in 2014. Between 1990 and 2014, life expectancy increased markedly in Collier
County, giving the county the distinction of having the second highest female life expectancy
among all counties in the US and the 11th highest longevity at birth among males.
Figure 3 emphasizes the variation in life expectancy at birth between males and females over
the 24 year period, 1990 to 2014.
267
This variation in life expectancy levels between females and males is clearly visible over the 24
year period, 1990–2014.
Leading Causes of Death
The ranking of causes of death is a standard method of presenting and analyzing mortality
statistics within a county, state and nation. Leading cause of death statistics have been
tabulated by the U.S. government and the states since the 1950’s and their ranking is a very
useful tool in assessing the burden and distribution of mortality by cause, age and sex.
The rank order of causes of death is based on the most frequently occurring causes of mortality
in terms of relative frequency of counts. The percentage distribution of these deaths are the
proportion of total deaths attributed to a specific cause and reflect the relative importance and
83.0
84.3
86.9
74.4
78.5
81.9
50.0 60.0 70.0 80.0 90.0
1990
2000
2014
Years
Figure 3. Life Expectancy at Birth by Sex, Collier County, 1990, 2000 and 2014
Males
Females
268
weight of each cause within a particular age and/or gender category. Cause-specific mortality
risk or the absolute burden of a specific disease or condition are measured by the crude and
age-adjusted death rates and are not necessarily the total number or frequency of a particular
cause.
The crude mortality rate a) as well as the age adjusted death rate b) will be observed as
decreasing or increasing over this period analyzed in Collier County depending on the specific
cause.
It should be emphasized that the exact ranking of causes of death do not necessarily coincide
with the causes of death of major public health importance. For example, deaths from motor
vehicle collisions and death from drownings are very important to our public health and the
community at large, yet they are subsumed in the broader category–unintentional injuries.
The current structure presented in this document of leading causes of death is the accepted
standard rankable list of causes that may be compared over time for analysis and evaluation
purposes within Collier County as well as with the state and the nation.
a) The number of persons dying during a calendar year within a defined geographical area divided by the number of persons at risk of dying during the
same time period residing within the same geographical area.
b) When mortality and other rates are analyzed across different populations or for the same population over time periods, crude rates are only
appropriate if influencing variables such as age remain constant. If the age distribution of a population or populations are changing or dissimilar, age–
adjusted rates should be computed for comparison purposes. Age-adjusted rates are calculated by “adjusting” the age distributions of populations to an
arbitrarily used standard population.
269
Tables 4 and 5 show the leading causes of death in Collier County for two periods, 2000 and
2014, respectively.
Table 4. Leading Causes of Death, All Ages, both Sexes, Collier County, 2000
Causes of Death Deaths
Percent
of Total
Deaths
Crude
Rate Per
100,000
Age-Adjusted
Death Rate
Per 100,000
*YPLL < 75
Per 100,000
Under 75
All Causes 2,319 100 910.9 607.8 6,695.60
Heart Disease 677 29.2 265.9 168.8 969.9
Cancer 586 25.3 230.2 144.4 1,681.20
Cerebrovascular Disease 150 6.5 58.9 36.3 93.5
Chronic Lower Respiratory
Disease 131 5.6 51.5 30.3 187.1
Unintentional Injuries 101 4.4 39.7 41.5 1,345.70
Alzheimer’s Disease 71 3.1 27.9 18.3 0.4
Diabetes Mellitus 49 2.1 19.2 11.8 91.3
Chronic Liver Disease and
Cirrhosis 40 1.7 15.7 11.1 213.9
Suicide 34 1.5 13.4 12.7 354.9
Influenza and Pneumonia 33 1.4 13 8.2 51.6
*Years of Potential Life Lost
270
Table 5. Leading Causes of Death, All Ages, both Sexes, Collier County, 2014
Causes of Death Deaths
Percent
of Total
Deaths
Crude
Rate Per
100,000
Age-Adjusted
Death Rate
Per 100,000
*YPLL< 75
Per 100,000
Under 75
All Causes 3,062 100 900.2 487.2 5,133.4
Cancer 782 25.5 229.9 120.8 1,209.4
Heart Disease 654 21.4 192.3 94.8 539
Alzheimer's Disease 186 6.1 54.7 25.1 19.2
Unintentional Injury 179 5.8 52.6 38.8 803.7
Chronic Lower Respiratory
Disease 177 5.8 52 25.3 139.6
Cerebrovascular Disease 167 5.5 49.1 23.9 113.3
Diabetes Mellitus 66 2.2 19.4 10.7 141.7
Chronic Liver Disease &
Cirrhosis 57 1.9 16.8 12.1 277.2
Parkinson’s Disease 45 1.5 13.2 6.1 1.7
Suicide 36 1.2 10.6 9.5 287.7
*Years of Potential Life Lost
Data Source: U.S. Census Bureau, Bureau of Vital Statistics. Calculations performed by FDOH–Collier County, Epidemiology Program
In 2014, the 10 leading causes of death in Collier County were cancer, heart disease,
Alzheimer’s disease, unintentional injuries, chronic lower respiratory disease, cerebrovascular
disease, diabetes mellitus, chronic liver disease and cirrhosis, Parkinson’s disease and suicide.
These 10 causes accounted for approximately 77 percent of all deaths occurring in the county.
Comparing the patterns of mortality to the year 2000, the following shifts have occurred.
During the period between 2000 and 2014 mortality from heart disease declined significantly
accounting for 21 percent of all deaths in 2014. Down from over 29 percent of the total number
of deaths in Collier County in 2000. This decrease has placed cancer as the leading cause of
death in Collier County while heart disease has shifted to the second leading cause. The
number of deaths due to Alzheimer’s disease between 2000 and 2014 increased by a
271
staggering 162 percent, while the number of total deaths from all causes had an increment of 32
percent over the same period.
Alzheimer’s disease, which was the 6th leading cause of death in 2000, now ranks as the third
leading cause, accounting for just over 6 percent of all deaths. This is a significant transition in
mortality due to Alzheimer’s disease which now accounts for over 6 percent of all deaths
annually in Collier County compared to just 3 percent in the year 2000. In 1990, Alzheimer’s
disease was not a leading cause of death. In 2000, there were 71 deaths from the disease, by
2014 the number had increased by 62 percent to 186. As the baby boomers cohort continues to
age and diagnosis and reporting of Alzheimer’s disease becomes more prevalent, this cause of
death will continue to play a leading role in the mortality pattern in Collier County, Florida and
the US. Overall in Collier County, between 2000 and 2014, mortality decreased for seven
leading causes and increased for two.
Diabetes remained the stationary seventh leading cause of death in the county during 2000 and
2014. While cerebrovascular disease was the third leading cause of death in 2000, in 2014, it
fell to 6th place. Unintentional injuries was the 5th leading cause in 2000, in 2014 it became the
4th leading cause of death.
Chronic liver disease and cirrhosis remained the 8th leading cause of death in 2014, just as in
2000. Of all of the comparable leading causes of death during both years only Alzheimer’s
disease and chronic liver disease and cirrhosis experienced increases in the age-adjusted death
rates.
By gender, the leading causes of death for males in Collier County remained almost identical in
ranking order between 2000 and 2014, with the exception of the reversal of heart disease and
cancer in first and second place, and the reversal of suicide and Parkinson’s disease in 9th and
10th placed respectively. The leading causes of death for females varied considerably by rank
order between 2000 and 2014. With the exception of chronic lower respiratory disease, the 4th
leading cause for both years, unintentional injuries, the 6th leading cause for both years and
diabetes, the 7th leading cause for both years. The remaining seven causes were all in different
orders with a number of select causes of death unique to only 2000 or 2014. (Influenza and
pneumonia and in 2000 and hypertensive renal disease and Parkinson’s disease in 2014).
(Tables 6 to 9).
272
Table 6. Leading Causes of Death, All Ages, Males, Collier County, 2000
Causes of Death Deaths
Percent
of Total
Deaths
Crude
Rate Per
100,000
Age-Adjusted
Death Rate
Per 100,000
*YPLL < 75
Per 100,000
Under 75
All Causes 1,265 100 992.9 723.7 8,805.9
Heart Disease 368 29.1 288.9 203.1 1,416.40
Cancer 321 25.4 252 165.5 1,600.80
Unintentional Injuries 70 5.5 54.9 59.6 2,107.70
Chronic Lower Respiratory
Disease 63 5.0 49.5 34.3 124.3
Cerebrovascular Diseases 58 4.6 45.5 28.4 174.8
Alzheimer’s Disease 30 2.4 23.5 15 122.6
Diabetes Mellitus 28 2.2 22 15.6 308.7
Chronic Liver Disease and
Cirrhosis 25 2.0 19.6 18.3 496.5
Suicide 21 1.7 16.5 10.9 0.9
Parkinson’s Disease 19 1.5 14.9 9.9 5.2
*Years of Potential Life Lost
273
Table 7. Leading Causes of Death, All Ages, Females, Collier County, 2000
Causes of Death Deaths
Percent
of Total
Deaths
Crude
Rate Per
100,000
Age-Adjusted
Death Rate
Per 100,000
*YPLL < 75
Per 100,000
Under 75
All Causes 1,054 100 828.8 499.7 4,541.7
Heart Disease 309 29.3 243 137.4 514.3
Cancer 265 25.1 208.4 128.3 1,763.30
Cerebrovascular Diseases 87 8.3 68.4 37.6 62.1
Chronic Lower Respiratory
Disease 73 6.9 57.4 31.9 199.7
Alzheimer’s Disease 50 4.7 39.3 22.7 0
Unintentional Injuries 31 2.9 24.4 22.2 567.9
Diabetes Mellitus 19 1.8 14.9 8.7 59.5
Influenza & Pneumonia 14 1.3 11 6.9 98.9
Chronic Liver Disease and
Cirrhosis 12 1.1 9.4 6.8 117.1
Atherosclerosis 11 1.0 8.6 4.7 1.8
*Years of Potential Life Lost
274
Table 8. Leading Causes of Death, All Ages, Males, Collier County, 2014
Causes of Death Deaths
Percent
of Total
Deaths
Crude
Rate Per
100,000
Age-Adjusted
Death Rate
Per 100,000
*YPLL < 75
Per 100,000
Under 75
All Causes 1,649 100 987 580.1 6,714.6
Cancer 431 26.1 258 141.4 1,277.5
Heart Disease 387 13.5 231.6 124.1 795.9
Unintentional Injury 108 6.5 64.6 55.3 1384.8
Chronic Lower Respiratory
Disease 79 4.8 47.3 24.5 131.2
Cerebrovascular Disease 75 4.5 44.9 23.9 133.2
Alzheimer's Disease 73 4.4 43.7 21.7 19.1
Diabetes Mellitus 39 2.4 23.3 14.5 215.9
Chronic Liver Disease &
Cirrhosis 38 2.3 22.7 16.9 381.2
Parkinson's Disease 30 1.8 18 8.8 2.7
Suicide 30 1.8 18 16 474.1
*Years of Potential Life Lost
275
Table 9. Leading Causes of Death, All Ages, Females, Collier County, 2014
Causes of Death Deaths
Percent
of Total
Deaths
Crude
Rate Per
100,000
Age-Adjusted
Death Rate
Per 100,000
*YPLL < 75
Per 100,000
Under 75
All Causes 1,413 100 816.4 400.8 3,591.7
Cancer 351 24.9 202.8 102.8 1,143.1
Heart Disease 267 18.9 154.3 69.2 288.4
Alzheimer’s Disease 113 8.0 65.3 27.9 19.3
Chronic Lower Respiratory
Disease 98 6.9 56.6 25.9 147.9
Cerebrovascular Disease 92 6.5 53.2 23.7 93.9
Unintentional Injury 71 5.0 41 21.7 237.1
Diabetes Mellitus 27 1.9 15.6 7.2 69.3
Chronic Liver Disease &
Cirrhosis 19 1.3 11 7.9 175.9
Hypertensive Renal Disease 17 1.2 9.8 4.6 26
Parkinson's Disease 15 1.1 8.7 3.8 0.7
*Years of Potential Life Lost
Data Source: U.S. Census Bureau, Bureau of Vital Statistics. Calculations performed by FDOH – Collier County, Epidemiology Program
A public health success is quite evident for influenza and pneumonia as a leading cause of
mortality. In 1990, it was the 6th leading cause of death and by 2000 it had fallen to the 10th
leading cause. In Collier County in 2014, influenza and pneumonia was the 12th leading cause
of mortality, by sex it was the 15th leading cause for females and the 11th leading cause for
males. This dramatic decrease in mortality can be attributed to an increase in the number of
those 65 years and over receiving the influenza and the pneumonia vaccinations. Public health
campaigns have been consistent during the past two decades over the importance of
immunizations to persons of all ages. The emergence of the 2009 N1H1 influenza pandemic
was instrumental in increasing community awareness of the risk of influenza and one of its most
severe complications, pneumonia.
276
Years of Potential Life Lost (YPLL)
The indicator Years of Potential Life Lost (YPLL) may be defined as the average number of
years that a person would have lived had he or she not died prematurely. It is a measure of the
relative impact of multiple diseases and conditions in a county, state or country, which illustrates
the losses suffered as a consequence of the death of a person, usually prior to age 75.
Compared to mortality rates, Years of Potential Life Lost places an emphasis on the processes
or catalysts underlying premature mortality in a geographical area. YPLL supplements the
mortality rate of a population by placing priority on and quantifying deaths in a county and state
which are considered preventable. YPLL by definition in public health may be interpreted as a
measure of preventable mortality for causes particularly those that are associated with life style
choices and behavioral risks.
The level of YPLL within a geographical area is correlated with the educational and income level
of the population as well as the public health prevention and planning strategies and priorities of
a community.
YPLL may be thought of as an inverse measure of life expectancy. As YPLL decreases over
time life expectancy at birth and at other ages increases on a relative basis. Figure 4 clearly
displays the relationship between levels of life expectancy and Years of Potential Life Lost for
Collier County.
277
Data Source: U.S. Census Bureau, Bureau of Vital Statistics. Calculations performed by FDOH – Collier County, Epidemiology Program
This relationship between YPLL and life expectancy can be described as a textbook inverse
statistical correlation. As YPLL decreases, life expectancy at birth increases.
Tables 10 and 11 show the Years of Potential Life Lost (YPLL) per 100,000 population for
females and males respectively, for 1990, 2000 and 2014. Steep declines in YPLL between
1990 and 2014 are visible for both sexes for several chronic diseases – cancer, heart disease,
and cerebrovascular disease. YPLL from influenza and pneumonia decreased significantly for
males and females by 55 percent each most likely related to increased levels of influenza
vaccination in the general population and pneumococcal pneumonia immunization in select
older age groups during this time period. While YPLL from unintentional injuries decreased by
66 percent for females and 52 percent for males, this cause remains the major cause of death
generating the most Years of Potential Life Lost for males in Collier County—placing it ahead of
cancer. For females, death from injuries generates less Years of Potential Life Lost than both
cancer and heart disease.
60
65
70
75
80
85
90
4000
5000
6000
7000
8000
9000
1990 2000 2014 Life Expectancy at Birth in YearsYPLL under 75 Years of Age per 100,000 Year
YPLL Life Expectancy
Figure 4. Years of Potential Life Lost Under 75 Years of Age per 100,000 Population and
Life Expectancy at Birth, Collier County, 1990, 2000 and 2013
278
Table 10. Years of Potential Life Lost Under 75 Years of Age per 100,000 Population, Females,
Collier County, 1990, 2000, and 2014
Disease or Condition 2014 2000 1990
Cancer 1143.1 1763.3 1962.6
Heart Disease 288.4 514.3 553.7
Unintentional Injuries 237.1 567.9 697.4
Chronic Liver Disease and
Cirrhosis 175.9 117.1 105.7
Chronic Lower Respiratory
Disease 147.9 199.7 91.6
Suicide 105.9 210.3 187.4
Cerebrovascular Disease 93.9 62.1 211.3
Diabetes Mellitus 69.3 59.5 50.7
Influenza & Pneumonia 38 98.9 84.5
Aortic Aneurysm &
Dissection 34 21.3 0
Viral Hepatitis 32.6 31.1 4.2
Homicide 30.6 117.1 94.4
Data Source: U.S. Census Bureau, Bureau of Vital Statistics. Calculations performed by FDOH – Collier County, Epidemiology Program
279
Table 11. Years of Potential Life Lost Under 75 Years of Age per 100,000 Population, Males,
Collier County, 1990, 2000 and 2014
Disease or Condition 2014 2000 1990
Unintentional Injuries 1384.8 2107.7 2895.0
Cancer 1277.5 1600.8 2209.0
Heart Disease 795.9 1416.4 1658.0
Suicide 474.1 496.5 744.3
Chronic Liver Disease and
Cirrhosis 381.2 308.7 187.8
Homicide 216.6 304.3 700.5
Diabetes Mellitus 215.9 122.6 187.8
Cerebrovascular Disease 133.2 124.3 262.7
Chronic Lower Respiratory
Disease 131.2 174.8 137.0
Septicemia 119.2 67.0 5.6
HIV Infection 43.7 303.5 572.0
Influenza and Pneumonia 41 5.2 91.8
Data Source: U.S. Census Bureau, Bureau of Vital Statistics. Calculations performed by FDOH – Collier County, Epidemiology Program
Diseases or conditions showing an increase in Years of Potential Life Lost between 1990 and
2014 include: chronic liver disease and cirrhosis—an increase of 66 percent for females and an
increase of 103 percent for males; chronic lower respiratory disease—an increase of 61 percent
in females and an increase of 69 percent for males; and diabetes mellitus—an increase of 150
percent for males and 37 percent for females.
YPLL from HIV infection declined dramatically over this period for both sexes; a decrease of 100
percent for females and 92 percent for males between 1990 and 2014. In 2014 there were no
female deaths attributed to HIV. These highly visible changes and mortality levels are resultant
of the introduction of antiretroviral therapy during the 1990’s that increased life expectancy
significantly for infected individuals.
280
Table 12 shows the ratio of Male to Female Years of Potential Life Lost per 100,000 population
by leading causes of death.
Table 12. Ratio of Male to Female Years of Potential Life Lost per 100,000 Population, by
Leading Causes of Death, Collier County, 2014
Cause YPLL for Males YPLL for
Females
Ratio of YPLL for Males
to Females
All Causes 6,714.6 3,591.7 1.87
Cancer 1277.5 1143.1 1.12
Unintentional Injury 1,384.8 237.1 5.84
Heart Disease 795.9 288.4 2.76
Suicide 474.1 105.9 4.48
Chronic Liver Disease &
Cirrhosis 381.2 175.9 2.17
Diabetes Mellitus 215.9 69.3 3.12
Chronic Lower Respiratory
Disease 131.2 147.9 0.89
Homicide 216.6 30.6 7.08
Cerebrovascular Diseases 133.2 93.9 1.42
Septicemia 119.2 16.7 7.14
Influenza & Pneumonia 41 38 1.08
Viral Hepatitis 21.9 32.6 0.67
HIV Infection 43.7 0 …*
Essen Hypertension &
Hypertensive Renal Disease 13 26 0.50
Alzheimer's Disease 19.1 19.3 0.99
*Unable to calculate ratio due to the fact that there were no female death related to HIV infection in 2014.
Data Source: U.S. Census Bureau, Bureau of Vital Statistics. Calculations performed by FDOH–Collier County, Epidemiology Program
281
A ratio of 1.00 indicates parity or no additional risk of males in Collier County losing years of life
expectancy prior to age 75 compared with females for the same particular cause.
A ratio of 4.00 would imply that males on average in Collier County lose years of potential life at
a four-fold higher rate than females prior to age 75 from a specific cause. An antithesis could be
a ratio of 0.50 which would imply that males on average will lose 50 percent less years of
potential life prior to age 75 compared to females in Collier County from the same cause of
death.
For all causes of death in Collier County in 2014, males lost 87 percent of expected years of life
from birth through age 75 more than females due predominantly to premature deaths from: 1)
unintentional injuries (accidents), 2) heart disease, 3) suicide, 4) chronic liver disease and
cirrhosis and 5) homicide. While suicide and homicide are not among the leading causes of
death, these two causes create a heavy burden on public health, particularly among males in
the local community, than other causes such as chronic lower respiratory disease, diabetes and
cerebrovascular disease. This is due to the fact that certain chronic and infectious diseases
contribute to mortality as expected at ages 75 and over. At the same time select violent causes
of death tend to occur at younger otherwise healthier ages thus subtracting years from an
otherwise expected average life expectancy.
282
Actual Causes of Death
Since the early 1990s the public health and medical community of the United States has been
placing emphasis and public importance on the major external and modifiable influences and
factors that contribute overwhelmingly to mortality in our communities. These lifestyle and
behavioral factors may not contribute to every single death; however, they are associated and
correlated with a plurality, if not a majority, of all deaths in every county and state in the United
States annually.
Due to the interval in time since the last analysis by the CDC, these actual causes of death
values may be lower or higher at the present time. For example, the number of deaths caused
by tobacco may have decreased, while the number of deaths due to overweight and obesity
may have increased since the last calculations.
Table 13 shows the leading causes of death in Collier County in 2014 contrasted with the actual
preventable causes of death for comparison.
283
Table 13. Leading Causes of Death in Collier County in 2014 contrasted with the
Actual Preventable Causes of Death for Comparison
Ten Leading Causes of
Death Number of Deaths Percentage
Distribution Actual Preventable
Causes of Death
Estimated
Number
Percentage
Distribution
Cancer 782 25.5 Tobacco 554 18.1
Heart Disease 654 21.4 Poor Diet and Physical
Inactivity 508 16.6
Alzheimer’s Disease 186 6.1 Alcohol Consumption 107 3.5
Unintentional Injuries 179 5.8 Infectious Diseases 95 3.1
Chronic Lower Respiratory
Disease 177 5.8 Toxic and Chemical Agents 70 2.3
Cerebrovascular Disease 167 5.5 Motor Vehicle Crashes 55 1.8
Diabetes Mellitus 66 2.2 Firearms 40 1.3
Chronic Liver Disease and
Cirrhosis 57 1.9 Sexual Behavior 25 0.8
Parkinson Disease 45 1.5 Illicit Drug Use 22 0.7
Suicide 36 1.2
Total, Ten Leading
Causes of Death 2,349 76.7 Actual Total Preventable
Causes of Death
1,476 48.2
All other Causes 713 23.3
Total 3,062 100.0
Data Source: Bureau of Vital Statistics. Calculations performed by FDOH – Collier County, Epidemiology Program
284
By inference, over 48 percent of all deaths, or almost one half on an annual basis, are
potentially preventable. In Collier County, mortality from all cancers and heart disease accounts
for 46.9 percent of all deaths annually. Cerebrovascular disease combined with unintentional
injuries (which includes fatal motor vehicle crashes) account for over 1 in 10 deaths in Collier
County every year. In 2014, one out of every 16 deaths was due to Alzheimer’s disease.
While tobacco has remained the leading cause of preventable mortality, overweight and obesity
resulting from poor diet and physical inactivity may overtake smoking in the near future as the
leading actual cause, as tobacco use has declined over the latter part of the 20th through the
21st century while the prevalence of overweight and obesity In the population is continuing to
increase at a consistent pace.
Tobacco use accounts for approximately one of every five deaths in Collier County each year. It
is the leading preventable cause of death in Collier County. In 2014, tobacco was responsible
for at least 554 deaths in Collier County
As the prevalence of overweight and obesity has increased in the United States, the risk of
death from cardiovascular disease, diabetes and kidney disease increases due to their medical
correlation. In Collier County in 2014, overweight and obesity were associated with at least 508
deaths.
Overweight, poor diet and physical inactivity in Collier County account for about another one in
six deaths annually. These life style behaviors also heavily contribute to Years of Potential Life
Lost, which in effect results in a reduction of life expectancy.
The abuse and misuse of alcohol accounts for about 3.5 percent of all deaths in the United
States. Alcohol related deaths include alcohol–related motor vehicle crashes, numerous site
specific cancers, cerebrovascular disease, hypertensive heart disease and chronic liver disease
and cirrhosis.
During 2014, at least 107 deaths were estimated to be alcohol attributable in Collier County.
The collective remaining lifestyle and behavioral actual causes of death include infectious
diseases, toxic chemical agents, motor vehicle crashes, firearms, sexual behavior and illicit drug
use, which accounted for approximately 10 percent of all deaths in Collier County or about one
in every ten deaths.
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The recent decline in life expectancy statistics for select demographic population groups
throughout the United States support the urgent need to continue to provide preventive
education and strategies within the public health system related to exercise and physical
activities as well as dietary choice and habits.